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@article{1796020, author = {Kridin, K. and Bruggen, M. C. and Chua, S. L. and Bygum, A. and Walsh, S. and Nageli, M. C. and Kucinskiene, V. and French, L. and Tetart, F. and Didona, B. and Milpied, B. and Ranki, A. and Salavastru, C. and Březinová, Eva and DivaniandPatel, S. and Lorentzen, T. and Nagel, J. L. and Valiukeviciene, S. and Karpaviciute, V. and Tiplica, G. S. and Oppel, E. and Oschmann, A. and de Prost, N. and Vorobyev, A. and IngenandHouszandOro, S.}, article_location = {Chicago, IL}, article_number = {10}, doi = {http://dx.doi.org/10.1001/jamadermatol.2021.3154}, keywords = {Stevens-Johnson Syndrome; Toxic Epidermal Necrolysis; Treatment Approaches; Outcomes}, language = {eng}, issn = {2168-6068}, journal = {JAMA dermatology}, title = {Assessment of Treatment Approaches and Outcomes in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Insights From a Pan-European Multicenter Study}, url = {https://jamanetwork.com/journals/jamadermatology/fullarticle/2783034}, volume = {157}, year = {2021} }
TY - JOUR ID - 1796020 AU - Kridin, K. - Bruggen, M. C. - Chua, S. L. - Bygum, A. - Walsh, S. - Nageli, M. C. - Kucinskiene, V. - French, L. - Tetart, F. - Didona, B. - Milpied, B. - Ranki, A. - Salavastru, C. - Březinová, Eva - Divani-Patel, S. - Lorentzen, T. - Nagel, J. L. - Valiukeviciene, S. - Karpaviciute, V. - Tiplica, G. S. - Oppel, E. - Oschmann, A. - de Prost, N. - Vorobyev, A. - Ingen-Housz-Oro, S. PY - 2021 TI - Assessment of Treatment Approaches and Outcomes in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Insights From a Pan-European Multicenter Study JF - JAMA dermatology VL - 157 IS - 10 SP - 1182-1190 EP - 1182-1190 PB - American Medical Association SN - 21686068 KW - Stevens-Johnson Syndrome KW - Toxic Epidermal Necrolysis KW - Treatment Approaches KW - Outcomes UR - https://jamanetwork.com/journals/jamadermatology/fullarticle/2783034 N2 - IMPORTANCE Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe drug reactions associated with a high rate of mortality and morbidity. There is no consensus on the treatment strategy. OBJECTIVE To explore treatment approaches across Europe and outcomes associated with the SJS/TEN disease course, as well as risk factors and culprit drugs. DESIGN, SETTING, AND PARTICIPANTS A retrospective pan-European multicenter cohort study including 13 referral centers belonging to the ToxiTEN ERN-skin subgroup was conducted. A total of 212 adults with SJS/TEN were included between January 1, 2015, and December 31, 2019, and data were collected from a follow-up period of 6 weeks. MAIN OUTCOMES AND MEASURES Risk factors for severe acute-phase complications (acute kidney failure, septicemia, and need for mechanical ventilation) and mortality 6 weeks following admission were evaluated using a multivariable-adjusted logistic regression model. One tool used in evaluation of severity was the Score of Toxic Epidermal Necrolysis (SCORTEN), which ranges from 0 to 7, with 7 the highest level of severity. RESULTS Of 212 patients (134 of 211 [63.7%] women; mean [SD] age, 51.0 [19.3] years), the mean (SD) body surface area detachment was 27% (32.8%). In 176 (83.0%) patients, a culprit drug was identified. Antibiotics (21.2%), followed by anticonvulsants (18.9%), nonsteroidal anti-inflammatory drugs (11.8%), allopurinol (11.3%), and sulfonamides (10.4%), were the most common suspected agents. Treatment approaches ranged from best supportive care only (38.2%) to systemic glucocorticoids (35.4%), intravenous immunoglobulins (23.6%), cyclosporine (10.4%), and antitumor necrosis factor agents (3.3%). Most patients (63.7%) developed severe acute-phase complications. The 6-week mortality rate was 20.8%. Maximal body surface area detachment (>= 30%) was found to be independently associated with severe acute-phase complications (fully adjusted odds ratio [OR], 2.49; 95% CI, 1.21-5.12; P = .01) and SCORTEN greater than or equal to 2 was significantly associated with mortality (fully adjusted OR, 10.30; 95% CI, 3.82-27.78; P < .001). Cyclosporine was associated with a higher frequency of greater than or equal to 20% increase in body surface area detachment in the acute phase (adjusted OR, 3.44; 95% CI, 1.12-10.52; P = .03) and an increased risk of infections (adjusted OR, 7.16; 95% CI, 1.52-33.74; P = .01). Systemic glucocorticoids and intravenous immunoglobulins were associated with a decreased risk of infections (adjusted OR, 0.40; 95% CI, 0.18-0.88; P = .02). No significant difference in 6-week mortality was found between treatment groups. CONCLUSIONS AND RELEVANCE This cohort study noted differences in treatment strategies for SJS/TEN in Europe; the findings suggest the need for prospective therapeutic studies to be conducted and registries to be developed. ER -
KRIDIN, K., M. C. BRUGGEN, S. L. CHUA, A. BYGUM, S. WALSH, M. C. NAGELI, V. KUCINSKIENE, L. FRENCH, F. TETART, B. DIDONA, B. MILPIED, A. RANKI, C. SALAVASTRU, Eva BŘEZINOVÁ, S. DIVANI-PATEL, T. LORENTZEN, J. L. NAGEL, S. VALIUKEVICIENE, V. KARPAVICIUTE, G. S. TIPLICA, E. OPPEL, A. OSCHMANN, N. DE PROST, A. VOROBYEV and S. INGEN-HOUSZ-ORO. Assessment of Treatment Approaches and Outcomes in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Insights From a Pan-European Multicenter Study. \textit{JAMA dermatology}. Chicago, IL: American Medical Association, 2021, vol.~157, No~10, p.~1182-1190. ISSN~2168-6068. Available from: https://dx.doi.org/10.1001/jamadermatol.2021.3154.
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