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The role of intravenous immunoglobulins in toxic epidermal necrolysis: a retrospective analysis of 64 patients managed in a specialized centre.
MedLine Citation:
PMID:  24007192     Owner:  NLM     Status:  Publisher    
BACKGROUND: Toxic epidermal necrolysis (TEN) is a severe cutaneous adverse drug reaction that is associated with mortality of 40%. Intravenous immunoglobulin (IVIg) is widely used as specific treatment for this reaction although evidence of its benefit is conflicting.
OBJECTIVES: We sought to evaluate if the use of IVIg improved mortality in patients with Stevens-Johnson syndrome/Toxic epidermal necrolysis overlap (SJS/TEN) and TEN.
METHODS: We retrospectively analyzed data for 64 patients with SJS/TEN overlap and TEN who were treated with IVIG in a single referral center. Primary outcome analyzed was in-hospital mortality. Predicted mortality was calculated based on their SCORTEN values. Secondary analyses of survival based on IVIG dosages and prior corticosteroid exposure were also performed.
RESULTS: There were 28 cases of SJS/TEN overlap and 36 TEN cases, with a mean SCORTEN value of 2.6. The mean dose of IVIg given was 2.4g/kg and the mean delay from the onset of epidermal detachment to administration of IVIg was 3.2 days. There were a total of 20 deaths (31.3%) in our cohort. The standardized mortality rate was 1.10 (CI: 0.62-1.58). Subgroup analysis comparing survivors and non survivors showed a higher SCORTEN in non survivors (3.4 versus 2.2). There were no differences with regards to IVIG dosage, delay and duration of IVIG administration. When stratified according to dosage, there was no mortality difference between patients who receive high dose (≥ 3g/kg) versus low dose (<3g/kg) IVIG.
CONCLUSION: This study showed that the use of IVIg does not yield survival benefits in SJS/TEN overlap and TEN, even when corrected for IVIg dosages. This article is protected by copyright. All rights reserved.
H Y Lee; Y L Lim; T Thirumoorthy; S M Pang
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-9-6
Journal Detail:
Title:  The British journal of dermatology     Volume:  -     ISSN:  1365-2133     ISO Abbreviation:  Br. J. Dermatol.     Publication Date:  2013 Sep 
Date Detail:
Created Date:  2013-9-6     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0004041     Medline TA:  Br J Dermatol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
This article is protected by copyright. All rights reserved.
Singapore General Hospital, Department of Dermatology, Outram Road, Singapore, 169608.
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