A meta-analysis of cyclosporine treatment for Stevens–Johnson syndrome/toxic epidermal necrolysis

Qin Xiang Ng,1,2 Michelle Lee Zhi Qing De Deyn,3 Nandini Venkatanarayanan,4 Collin Yih Xian Ho,2 Wee-Song Yeo,5 1Department of Medicine, National University Hospital, National University Health System, Singapore; 2MOH Holdings Pte Ltd, Singapore; 3Department of Medicine, James Cook University Hospit...

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Autores principales: Ng QX, De Deyn MLZQ, Venkatanarayanan N, Ho CYX, Yeo WS
Formato: article
Lenguaje:EN
Publicado: Dove Medical Press 2018
Materias:
SJS
TEN
CsA
Acceso en línea:https://doaj.org/article/307d3c095de646f7b9fef75e9c5998f3
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spelling oai:doaj.org-article:307d3c095de646f7b9fef75e9c5998f32021-12-02T04:14:41ZA meta-analysis of cyclosporine treatment for Stevens–Johnson syndrome/toxic epidermal necrolysis1178-7031https://doaj.org/article/307d3c095de646f7b9fef75e9c5998f32018-03-01T00:00:00Zhttps://www.dovepress.com/a-meta-analysis-of-cyclosporine-treatment-for-stevens-johnson-syndrome-peer-reviewed-article-JIRhttps://doaj.org/toc/1178-7031Qin Xiang Ng,1,2 Michelle Lee Zhi Qing De Deyn,3 Nandini Venkatanarayanan,4 Collin Yih Xian Ho,2 Wee-Song Yeo,5 1Department of Medicine, National University Hospital, National University Health System, Singapore; 2MOH Holdings Pte Ltd, Singapore; 3Department of Medicine, James Cook University Hospital, Middlesbrough, UK; 4Department of Medicine, Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, Nottingham, UK; 5Department of Paediatrics, National University Hospital, National University Health System, Singapore Background: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are dermatologic emergencies with high morbidity and mortality risk. Cyclosporine, an immunomodulatory agent, is sometimes used off-label, and its role continues to be debated. This meta-analysis aimed to provide an update of current evidence and to clarify the role of cyclosporine in SJS/TEN treatment better.Methods: Using the keywords [cyclosporine OR cyclosporine OR ciclosporin OR CsA] AND [Steven-Johnson OR SJS OR toxic epidermal OR epidermal necrolysis OR TEN OR hypersensitivity OR dermatologic OR burns], a preliminary search on the PubMed, Ovid, Web of Science, and Google Scholar Database yielded 615 papers published in English between January 1, 1960 and July 1, 2017. The inclusion criteria for this review were: 1) published retrospective or prospective study (excluding single case reports); 2) patients with clinical diagnosis of SJS or TEN; 3) trial of cyclosporine treatment; and 4) available survival/mortality data.Results: A total of 12 studies, with a total of 358 SJS/TEN patients were reviewed. Two studies were excluded from the meta-analysis as they did not report SCORe of toxic epidermal necrosis/predicted mortality data; one was excluded because of possible data irregularities. Meta-analysis of nine studies revealed a significant reduction in mortality risk with cyclosporine therapy (standardized mortality ratio 0.320; 95% CI: 0.119–0.522; P=0.002). Cyclosporine was also generally well tolerated with little adverse effects or increased infection, albeit the patients tended to be critically ill. Publication bias was observed in the funnel plot and Egger test (P=0.0467).Conclusion: Currently available evidence are predominantly open trials and retrospective studies with a significant risk of bias, perhaps owing to the rarity and life-threatening nature of the condition. Given its immunomodulatory actions, cyclosporine could be a potential treatment option for SJS/TEN in addition to best supportive measures. Further confirmation with robust randomized, controlled trials or larger case series is necessary and should be encouraged. Keywords: SJS, TEN, epidermal necrolysis, cyclosporine, CsA, meta-analysisNg QXDe Deyn MLZQVenkatanarayanan NHo CYXYeo WSDove Medical PressarticleSJSTENepidermal necrolysiscyclosporineCsAmeta-analysisPathologyRB1-214Therapeutics. PharmacologyRM1-950ENJournal of Inflammation Research, Vol Volume 11, Pp 135-142 (2018)
institution DOAJ
collection DOAJ
language EN
topic SJS
TEN
epidermal necrolysis
cyclosporine
CsA
meta-analysis
Pathology
RB1-214
Therapeutics. Pharmacology
RM1-950
spellingShingle SJS
TEN
epidermal necrolysis
cyclosporine
CsA
meta-analysis
Pathology
RB1-214
Therapeutics. Pharmacology
RM1-950
Ng QX
De Deyn MLZQ
Venkatanarayanan N
Ho CYX
Yeo WS
A meta-analysis of cyclosporine treatment for Stevens–Johnson syndrome/toxic epidermal necrolysis
description Qin Xiang Ng,1,2 Michelle Lee Zhi Qing De Deyn,3 Nandini Venkatanarayanan,4 Collin Yih Xian Ho,2 Wee-Song Yeo,5 1Department of Medicine, National University Hospital, National University Health System, Singapore; 2MOH Holdings Pte Ltd, Singapore; 3Department of Medicine, James Cook University Hospital, Middlesbrough, UK; 4Department of Medicine, Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, Nottingham, UK; 5Department of Paediatrics, National University Hospital, National University Health System, Singapore Background: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are dermatologic emergencies with high morbidity and mortality risk. Cyclosporine, an immunomodulatory agent, is sometimes used off-label, and its role continues to be debated. This meta-analysis aimed to provide an update of current evidence and to clarify the role of cyclosporine in SJS/TEN treatment better.Methods: Using the keywords [cyclosporine OR cyclosporine OR ciclosporin OR CsA] AND [Steven-Johnson OR SJS OR toxic epidermal OR epidermal necrolysis OR TEN OR hypersensitivity OR dermatologic OR burns], a preliminary search on the PubMed, Ovid, Web of Science, and Google Scholar Database yielded 615 papers published in English between January 1, 1960 and July 1, 2017. The inclusion criteria for this review were: 1) published retrospective or prospective study (excluding single case reports); 2) patients with clinical diagnosis of SJS or TEN; 3) trial of cyclosporine treatment; and 4) available survival/mortality data.Results: A total of 12 studies, with a total of 358 SJS/TEN patients were reviewed. Two studies were excluded from the meta-analysis as they did not report SCORe of toxic epidermal necrosis/predicted mortality data; one was excluded because of possible data irregularities. Meta-analysis of nine studies revealed a significant reduction in mortality risk with cyclosporine therapy (standardized mortality ratio 0.320; 95% CI: 0.119–0.522; P=0.002). Cyclosporine was also generally well tolerated with little adverse effects or increased infection, albeit the patients tended to be critically ill. Publication bias was observed in the funnel plot and Egger test (P=0.0467).Conclusion: Currently available evidence are predominantly open trials and retrospective studies with a significant risk of bias, perhaps owing to the rarity and life-threatening nature of the condition. Given its immunomodulatory actions, cyclosporine could be a potential treatment option for SJS/TEN in addition to best supportive measures. Further confirmation with robust randomized, controlled trials or larger case series is necessary and should be encouraged. Keywords: SJS, TEN, epidermal necrolysis, cyclosporine, CsA, meta-analysis
format article
author Ng QX
De Deyn MLZQ
Venkatanarayanan N
Ho CYX
Yeo WS
author_facet Ng QX
De Deyn MLZQ
Venkatanarayanan N
Ho CYX
Yeo WS
author_sort Ng QX
title A meta-analysis of cyclosporine treatment for Stevens–Johnson syndrome/toxic epidermal necrolysis
title_short A meta-analysis of cyclosporine treatment for Stevens–Johnson syndrome/toxic epidermal necrolysis
title_full A meta-analysis of cyclosporine treatment for Stevens–Johnson syndrome/toxic epidermal necrolysis
title_fullStr A meta-analysis of cyclosporine treatment for Stevens–Johnson syndrome/toxic epidermal necrolysis
title_full_unstemmed A meta-analysis of cyclosporine treatment for Stevens–Johnson syndrome/toxic epidermal necrolysis
title_sort meta-analysis of cyclosporine treatment for stevens–johnson syndrome/toxic epidermal necrolysis
publisher Dove Medical Press
publishDate 2018
url https://doaj.org/article/307d3c095de646f7b9fef75e9c5998f3
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