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Drug Reactions

Immune Checkpoint Inhibitors

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  • A systematic review and meta-analysis demonstrated that immune-related cutaneous adverse reactions occurring during immune checkpoint inhibitor treatment were associated with improved overall survival, HR 0.61. (37672255)

STEVENS-JOHNSON SYNDROME/TEN​​

 

Causes                                                                                                                                                                                                           

Lee EY, Knox C, Phillips EJ. Worldwide Prevalence of Antibiotic-Associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Systematic Review and Meta-analysis. JAMA Dermatol. 2023. PMID: 36790777.

  • Key statistics from this meta-analysis:

    • 86% of cases could be determined to be caused by a single drug (14% multiple potential drug triggers).​

    • Antibiotics cause 28% of cases of SJS/TEN.  Anticonvulsants, allopurinol, and NSAIDs were other common triggers.  Infection was uncommon.

    • 32% of antibiotic-associated cases were from sulfonamides, 22% penicillins, 11% cephalosporins, 4% fluoroquinolones, 2% macrolides.

  • MY CRITIQUE: authors use some confusing phrasing like "proportion of antibiotics associated with SJS/TEN" and "proportion of antibiotics triggering drug-associated SJS/TEN", when they likely mean the proportion of cases associated with or triggered by antibiotics.  The distinction between "associated with" and "triggering drug-associated" is unclear too. ​

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Predicting Mortality                                                                                                                                                                                       

  • There has been some back and forth between SCORTEN and ABCD-10 over the last few years attempting to demonstrate which is the more predictive scoring system. 

Koh HK, Fook-Chong S, Lee HY. Assessment and Comparison of Performance of ABCD-10 and SCORTEN in Prognostication of Epidermal Necrolysis. JAMA Dermatol. 2020. PMID: 33084873.

This study determined SCORTEN to be more superior to ABCD-10.

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Treatments                                                                                                                                                                                                     

Plasmapheresis

  • After ineffective systemic corticosteroids, plasmapheresis provides no benefit compared to IVIg and is associated with increased costs and longer hospital stays. 36884227

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