Treating toxic epidermal necrolysis with systemic immunomodulating therapies: A systematic review and network meta-analysis.
Tsai, Tsung-Yu MD a, b; Huang, I-Hsin MD c; Chao, Yuan-Chen MD d; Li, Hua MA e; Hsieh, Tyng-Shiuan MD d; Wang, Hsiao-Han MD a, b, f; Huang, Yu-Ting MA g; Chen, Chun-Yuan PhD b, h; Cheng, Ying-Chih MD e, i; Kuo, Po-Hsiu PhD e; Huang, Yu-Chen MD a, b, f, *; Tu, Yu-Kang DDS, PhD b, e, j, *
[Article] Journal of the American Academy of Dermatology. 84(2):390-397, February 2021.

(Format: HTML, PDF)

Background: Various systemic immunomodulating therapies have been used to treat toxic epidermal necrolysis (TEN), but their efficacy remains unclear.

Objective: To perform a systematic review and network meta-analysis (NMA) evaluating the effects of systemic immunomodulating therapies on mortality for Stevens-Johnson syndrome (SJS)/TEN overlap and TEN.

Methods: A literature search was performed in online databases (from inception to October 31, 2019). Outcomes were mortality rates and Score of Toxic Epidermal Necrolysis (SCORTEN)-based standardized mortality ratio (SMR). A frequentist random-effects model was adopted.

Results: Sixty-seven studies involving 2079 patients were included. An NMA of 10 treatments showed that none was superior to supportive care in reducing mortality rates and that thalidomide was associated with a significantly higher mortality rate (odds ratio, 11.67; 95% confidence interval [CI], 1.42-95.96). For SMR, an NMA of 11 treatment arms showed that corticosteroids and intravenous immunoglobulin combination therapy was the only treatment with significant survival benefits (SMR, 0.53; 95% CI, 0.31-0.93).

Limitations: Heterogeneity and a paucity of eligible randomized controlled trials.

Conclusions: Combination therapy with corticosteroids and IVIg may reduce mortality risks in patients with SJS/TEN overlap and TEN. Cyclosporine and etanercept are promising therapies, but more studies are required to provide clearer evidence.

(C) 2021 by Mosby, Inc.