Effects of treatments on the mortality of Stevens-Johnson syndrome and toxic epidermal necrolysis: A retrospective study on patients included in the prospective EuroSCAR Study.
ABSTRACT No treatment modality has been established as standard for patients with Stevens-Johnson syndrome and toxic epidermal necrolysis.
We sought to evaluate the effect of treatment on mortality in a large cohort of patients with Stevens-Johnson syndrome or toxic epidermal necrolysis.
Data on therapy were retrospectively collected from patients in France and Germany enrolled in EuroSCAR, a case-control study of risk factors.
Neither intravenous immunoglobulins nor corticosteroids showed any significant effect on mortality in comparison with supportive care only. Compared with supportive care, odds ratios for death were 1.4 (95% confidence interval: 0.6-4.3) for intravenous immunoglobulins in France and 1.5 (0.5-4.4) in Germany, and 0.4 (0.1-1.7) for corticosteroids in France and 0.3 (0.1-1.1) in Germany.
Such an observational study with retrospective data collection has obvious limitations, including heterogeneity between the countries, supportive care, treatment doses, and durations.
We found no sufficient evidence of a benefit for any specific treatment. The trend for a beneficial effect of corticosteroids deserves further exploration.
SourceAvailable from: Ernest Law[Show abstract] [Hide abstract]
ABSTRACT: Objective: To review the evidence for the use of steroids in adults presenting with Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), or overlap. Data Sources: EMBASE (1974 to April 2014), MEDLINE (1946 to April 2014), Cochrane Database of Systematic Reviews, and International Pharmaceutical Abstracts (1970 to January 2014) were searched using the terms: prednisone, methylprednisolone, dexamethasone, prednisolone, steroids, glucocorticoids, corticosteroids, Stevens-Johnson Syndrome, toxic epidermal necrolysis, and SJS/TEN overlap. Study Selection and Data Extraction: English-language, full reports of experimental and observational studies were included. Bibliographies from pertinent publications were reviewed for additional references. Prespecified outcomes included survival, survival to discharge, hospitalization without intensive care, length of intensive care stay, duration of hospitalization, ophthalmological complications, infection rates, and adverse events. Data Synthesis: Six studies that used steroids for SJS, TEN, and/or overlap were included. All studies were retrospective cohort studies with no case-control or cross-sectional studies; 5 studies reported on steroid doses, and 2 studies reported time from disease onset to steroid use (2-4 days). Only 1 of 6 studies reported a statistically significant impact on mortality with steroids use (odds ratio = 0.4; 95% CI = 0.2-0.9). Adverse event rates were not reported in any of the studies. Conclusions: A review of the current evidence reveals a need for prospective, randomized controlled studies to provide more definitive conclusions on steroid use in patients with SJS, TEN, and/or overlap.Annals of Pharmacotherapy 11/2014; 49(3):335-342. DOI:10.1177/1060028014560012 · 2.92 Impact Factor
Indian Journal of Dermatology 01/2009; 54(1). DOI:10.4103/0019-5154.48996
Chapter: Patología ocular[Show abstract] [Hide abstract]
ABSTRACT: La farmacología ocular es compleja y en muchas ocasiones se hace complicado dar explicación científica a muchos de los sucesos que ocurren día a día, en la práctica clínica. Se trata de manera esquemática y sencilla el tratamiento farmacológico de la querarititis bacterianas, conjuntivitis y glaucoma.Manual del residente de Farmacia Hospitalaria Tomo II, 11/2014: chapter Patología ocular: pages 229-250; , ISBN: 978-84-7989-793-2