Efficacy of cyclosporine for the treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis: Systemic review and meta-analysis
Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening reactions, mainly to drug, characterized by epidermal necrosis and mucous membrane ulceration. SCORTEN-predicted mortality has been used to assess the efficacy of treatments comparing with actual mor...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2017-09-01
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| Series: | Dermatologica Sinica |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S102781171630101X |
| _version_ | 1818141027695853568 |
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| author | Yu-Tsung Chen Che-Yuan Hsu Yu-Ning Chien Woan-Ruoh Lee Yu-Chen Huang |
| author_facet | Yu-Tsung Chen Che-Yuan Hsu Yu-Ning Chien Woan-Ruoh Lee Yu-Chen Huang |
| author_sort | Yu-Tsung Chen |
| collection | DOAJ |
| description | Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening reactions, mainly to drug, characterized by epidermal necrosis and mucous membrane ulceration. SCORTEN-predicted mortality has been used to assess the efficacy of treatments comparing with actual mortality. Several literatures about cyclosporine have shown its ability to halt disease progression and decrease mortality.
Objectives: This study was aimed to provide a more evidence-based review by conducting a meta-analysis of cyclosporine for the treatment of SJS/TEN.
Methods: We conducted a systemic review of articles published before Jan 31, 2017. The outcomes were mortality rate and SCORTEN-based standardized mortality ratio (SMR). The pooled odds ratio (OR) and SMR ratio were analyzed from these extracted data.
Results: There were 7 observational controlled studies (1 historical controlled study) which met the inclusion criteria. The overall mortality rate for patients receiving cyclosporine was 7.1%. The observed mortality was significantly lower than predicted mortality in patients receiving cyclosporine (pooled SMR: 0.42; 95% CI, 0.19–0.95). The pooled estimate of ORs for 4 studies describing observed mortality in cyclosporine to intravenous immunoglobulins (IVIg) group was 0.40 (95%CI, 0.06–2.69). Comparison of SMR between cyclosporine and IVIg was presented with the pooled SMR ratio, which showed no significant difference in SMR ratio between two treatments (SMR ratio, 0.49, 95% CI, 0.08–2.89).
Conclusion: We have provided the first meta-analysis study regarding the efficacy on mortality of cyclosporine for treatment of SJS/TEN. From the existing research, cyclosporine has a beneficial effect on mortality. And there is a trend that cyclosporine demonstrated better survival whether in pooled OR or SMR ratio than IVIg. Due to the limitations of current studies, a double-blind randomized controlled trial is still urged. |
| first_indexed | 2024-12-11T10:53:21Z |
| format | Article |
| id | doaj.art-a866727789b8473a89b005f930a3267c |
| institution | Directory Open Access Journal |
| issn | 1027-8117 |
| language | English |
| last_indexed | 2024-12-11T10:53:21Z |
| publishDate | 2017-09-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Dermatologica Sinica |
| spelling | doaj.art-a866727789b8473a89b005f930a3267c2022-12-22T01:10:12ZengWolters Kluwer Medknow PublicationsDermatologica Sinica1027-81172017-09-0135313113710.1016/j.dsi.2017.04.004Efficacy of cyclosporine for the treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis: Systemic review and meta-analysisYu-Tsung Chen0Che-Yuan Hsu1Yu-Ning Chien2Woan-Ruoh Lee3Yu-Chen Huang4Department of Dermatology, Shuang Ho Hospital, Taipei Medical University, Taipei, TaiwanDepartment of Dermatology, Shuang Ho Hospital, Taipei Medical University, Taipei, TaiwanSchool of Public Health, College of Public Health and Nutrition; Taipei Medical University, Taipei, TaiwanDepartment of Dermatology, Shuang Ho Hospital, Taipei Medical University, Taipei, TaiwanDepartments of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, TaiwanBackground: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening reactions, mainly to drug, characterized by epidermal necrosis and mucous membrane ulceration. SCORTEN-predicted mortality has been used to assess the efficacy of treatments comparing with actual mortality. Several literatures about cyclosporine have shown its ability to halt disease progression and decrease mortality. Objectives: This study was aimed to provide a more evidence-based review by conducting a meta-analysis of cyclosporine for the treatment of SJS/TEN. Methods: We conducted a systemic review of articles published before Jan 31, 2017. The outcomes were mortality rate and SCORTEN-based standardized mortality ratio (SMR). The pooled odds ratio (OR) and SMR ratio were analyzed from these extracted data. Results: There were 7 observational controlled studies (1 historical controlled study) which met the inclusion criteria. The overall mortality rate for patients receiving cyclosporine was 7.1%. The observed mortality was significantly lower than predicted mortality in patients receiving cyclosporine (pooled SMR: 0.42; 95% CI, 0.19–0.95). The pooled estimate of ORs for 4 studies describing observed mortality in cyclosporine to intravenous immunoglobulins (IVIg) group was 0.40 (95%CI, 0.06–2.69). Comparison of SMR between cyclosporine and IVIg was presented with the pooled SMR ratio, which showed no significant difference in SMR ratio between two treatments (SMR ratio, 0.49, 95% CI, 0.08–2.89). Conclusion: We have provided the first meta-analysis study regarding the efficacy on mortality of cyclosporine for treatment of SJS/TEN. From the existing research, cyclosporine has a beneficial effect on mortality. And there is a trend that cyclosporine demonstrated better survival whether in pooled OR or SMR ratio than IVIg. Due to the limitations of current studies, a double-blind randomized controlled trial is still urged.http://www.sciencedirect.com/science/article/pii/S102781171630101XCyclosporineMeta-analysisStevens-Johnson syndromeSystemic reviewToxic epidermal necrolysis |
| spellingShingle | Yu-Tsung Chen Che-Yuan Hsu Yu-Ning Chien Woan-Ruoh Lee Yu-Chen Huang Efficacy of cyclosporine for the treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis: Systemic review and meta-analysis Dermatologica Sinica Cyclosporine Meta-analysis Stevens-Johnson syndrome Systemic review Toxic epidermal necrolysis |
| title | Efficacy of cyclosporine for the treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis: Systemic review and meta-analysis |
| title_full | Efficacy of cyclosporine for the treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis: Systemic review and meta-analysis |
| title_fullStr | Efficacy of cyclosporine for the treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis: Systemic review and meta-analysis |
| title_full_unstemmed | Efficacy of cyclosporine for the treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis: Systemic review and meta-analysis |
| title_short | Efficacy of cyclosporine for the treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis: Systemic review and meta-analysis |
| title_sort | efficacy of cyclosporine for the treatment of stevens johnson syndrome and toxic epidermal necrolysis systemic review and meta analysis |
| topic | Cyclosporine Meta-analysis Stevens-Johnson syndrome Systemic review Toxic epidermal necrolysis |
| url | http://www.sciencedirect.com/science/article/pii/S102781171630101X |
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