Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis associated with anticonvulsants in a Japanese population: Matched case–control and cohort studies

Fukasawa, Toshiki; Takahashi, Hayato; Takahashi, Kyoko; Tanemura, Nanae; Amagai, Masayuki; Urushihara, Hisashi

doi:10.1016/j.alit.2021.01.004

Cited by 12 publications

(10 citation statements)

References 39 publications

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“…Studies that rely on database or registry data may be more capable of overcoming certain reporting biases. For instance, Fukasawa et al ( 16 ) used a large-scale employee claims database that includes longitudinal inpatient, outpatient, and pharmacy information for all employees receiving national coverage to approximate the true and relative risk of SJS/TEN in the Japanese population ( 77 ). However, selection bias may still be involved from excluding cases that arise from uncommon medications or causes that are not recorded in the database ( 9 , 62 ).…”

Section: Discussionmentioning

confidence: 99%

Stevens-Johnson syndrome and toxic epidermal necrolysis: A systematic review of PubMed/MEDLINE case reports from 1980 to 2020

et al. 2022

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BackgroundStevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, life-threatening immunologic reactions. Prior studies using electronic health records, registries or reporting databases are often limited in sample size or lack clinical details. We reviewed diverse detailed case reports published over four decades.MethodsStevens-Johnson syndrome and toxic epidermal necrolysis-related case reports were identified from the MEDLINE database between 1980 and 2020. Each report was classified by severity (i.e., SJS, TEN, or SJS-TEN overlap) after being considered a “probable” or “definite” SJS/TEN case. The demographics, preconditions, culprit agents, clinical course, and mortality of the cases were analyzed across the disease severity.ResultsAmong 1,059 “probable” or “definite” cases, there were 381 (36.0%) SJS, 602 (56.8%) TEN, and 76 (7.2%) SJS-TEN overlap cases, with a mortality rate of 6.3%, 24.4%, and 21.1%, respectively. Over one-third of cases had immunocompromised conditions preceding onset, including cancer (n = 194,18.3%), autoimmune diseases (n = 97, 9.2%), and human immunodeficiency virus (HIV) (n = 52, 4.9%). During the acute phase of the reaction, 843 (79.5%) cases reported mucous membrane involvement and 210 (19.8%) involved visceral organs. Most cases were drug-induced (n = 957, 90.3%). A total of 379 drug culprits were reported; the most frequently reported drug were antibiotics (n = 285, 26.9%), followed by anticonvulsants (n = 196, 18.5%), analgesics/anesthetics (n = 126, 11.9%), and antineoplastics (n = 120, 11.3%). 127 (12.0%) cases reported non-drug culprits, including infections (n = 68, 6.4%), of which 44 were associated with a mycoplasma pneumoniae infection and radiotherapy (n = 27, 2.5%).ConclusionAn expansive list of potential causative agents were identified from a large set of literature-reported SJS/TEN cases, which warrant future investigation to understand risk factors and clinical manifestations of SJS/TEN in different populations.

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Section: Discussionmentioning

confidence: 99%

Stevens-Johnson syndrome and toxic epidermal necrolysis: A systematic review of PubMed/MEDLINE case reports from 1980 to 2020

et al. 2022

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“…A retrospective cohort study was conducted using data from an employment-based health insurance claims database in Japan constructed by JMDC (Tokyo, Japan). [21][22][23][24] The database can track individual medical encounters and healthcare resource consumption covered by health insurance across multiple medical institutions on an individual basis as long as people are enrolled in a single health insurance coverage. Members withdraw from health insurance associations at the time of their retirement, which usually occurs at 65 years of age in Japan where lifetime employment has been the norm, and change insurers at the time of changing jobs.…”

Section: Methodsmentioning

confidence: 99%

“…A retrospective cohort study was conducted using data from an employment‐based health insurance claims database in Japan constructed by JMDC (Tokyo, Japan) 21–24 . The database can track individual medical encounters and healthcare resource consumption covered by health insurance across multiple medical institutions on an individual basis as long as people are enrolled in a single health insurance coverage.…”

Section: Methodsmentioning

confidence: 99%

Comparison of the incidence of bleeding between baloxavir marboxil and other anti‐influenza drugs among outpatients with influenza virus infection: A retrospective cohort study using an employment‐based health insurance claims database in Japan

Hara

Komeda

et al. 2021

Pharmacoepidemiology and Drug

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Purpose: Alerts for bleeding events are included in the Japanese package inserts of some anti-influenza drugs, including baloxavir marboxil and oseltamivir. However, there are few reports on the incidence of bleeding events during treatment with antiinfluenza drugs. This large-scale quantitative assessment compared the incidence of bleeding events in influenza patients treated with baloxavir and other anti-influenza drugs and in untreated patients.Methods: This retrospective cohort study used a large-scale Japanese employmentbased health insurance claims database provided by JMDC Inc. and included outpatients diagnosed with influenza between October 1, 2018 and April 11, 2019. Bleeding events were identified by International Classification of Diseases 10th revision codes. Incidences were compared between patients treated with baloxavir or neuraminidase inhibitors and untreated patients.Odds ratios were calculated after exact matching to adjust for potential confounders.

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“…These syndromes are strongly linked to anticonvulsants, as seen in our case, but they can also be caused by other medications such as penicillin, sulfonamides, and nonsteroidal anti-inflammatory drugs [ 7 ]. The most common offending anticonvulsants are phenytoin, carbamazepine, oxcarbazepine, phenobarbital, and lamotrigine [ 8 ]. In our case, phenytoin was determined to be the causative agent as it had been started 15 days prior to the symptom onset, and her clinical status promptly resolved after discontinuation.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Steven-Johnson/Toxic Epidermal Necrolysis Overlap Syndrome

Toledo-Martinez¹,

Galdamez-Carcamo²,

Somoza-Cano³

et al. 2022

Cureus

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Steven-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening mucocutaneous reactions that are predominantly drug-induced. Treatment varies depending on the severity, but even with accurate medical management, the mortality rate can be up to 50% in severe cases. Recurrent episodes with different agents are uncommon, but they have been reported in the literature. We present a case of a 30year-old female presenting with recurrent SJS/TEN overlap syndrome complicated by sepsis after phenytoin use. Records revealed a previous episode after carbamazepine use one month prior to the current presentation and a first episode 23 years ago with an unknown medication. The offending agent was discontinued, the appropriate treatment was given, and the patient's clinical status significantly improved. This case highlights the life-threatening manifestation of a mucocutaneous reaction. Prompt clinical assessment is paramount for patient survival.

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Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis associated with anticonvulsants in a Japanese population: Matched case–control and cohort studies

Cited by 12 publications

References 39 publications

Stevens-Johnson syndrome and toxic epidermal necrolysis: A systematic review of PubMed/MEDLINE case reports from 1980 to 2020

Stevens-Johnson syndrome and toxic epidermal necrolysis: A systematic review of PubMed/MEDLINE case reports from 1980 to 2020

Comparison of the incidence of bleeding between baloxavir marboxil and other anti‐influenza drugs among outpatients with influenza virus infection: A retrospective cohort study using an employment‐based health insurance claims database in Japan

Recurrent Steven-Johnson/Toxic Epidermal Necrolysis Overlap Syndrome

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