Steroids for SJS and TEN?
Here’s a quick hit summary of the evidence regarding the use of systemic corticosteroids in the treatment of SJS/TEN
- Small amount of evidence, NO RCT to date
- Small retrospective study (n=30, groups comparable) in 1984 from a burn center found survival benefit (66% versus 33% survival) in NOT giving steroids. Also found decreased complications such as Candida sepsis & esophageal ulcer in patients who did NOT receive steroids.
- Cohort of ~500 patients from RegiSCAR (International Registry of Severe Cutaneous Adverse Reactions to Drugs)
- No statistical diff in Hazard Ratio among treatment groups (supportive care vs. corticosteroids vs. IVIG).
- Systematic Review of literature from 2001-2009 (only used Pubmed, not great)
- Pooled analysis demonstrated no statistically significant difference in Mortality Ratio among groups (supportive care vs. corticosteroids vs. IVIG).
- B.: i2 statistic not reported but authors mention no problematic heterogeneity.
- Very small study (n=12 over 10 years) demonstrated potential benefit to early pulse-dose IV steroids (1.5 mg/kg/day dexamethasone for 3 days) in the form of (1) disease halt at 3 days (2) 1 actual death versus 4 predicted deaths.
- Interestingly, a case-control study (case n=92; control n=381) demonstrated that pre-existing chronic steroid use delayed onset of SJS/TEN in patients using high-risk drugs by 7 days but also prolonged disease course by 2 days.
- Systemic corticosteroids have not been shown to consistently correlate or provide a survival benefit in patients with SJS/TEN.
- Paucity of evidence may show benefit to pulse-dose IV steroids such as are used in the treatment of autoimmune diseases such as pemphigus vulgaris.
- Supportive care is the standard of care.
Post by: Dr. Katrina D’Amore DO, MPH