Treating toxic epidermal necrolysis with systemic immunomodulating therapies: A systematic review and network meta-analysis

Tsung Yu Tsai, I. Hsin Huang, Yuan Chen Chao, Hua Li, Tyng Shiuan Hsieh, Hsiao Han Wang, Yu Ting Huang, Chun Yuan Chen, Ying Chih Cheng, Po Hsiu Kuo, Yu Chen Huang, Yu Kang Tu

研究成果: 雜誌貢獻文章同行評審

6 引文 斯高帕斯(Scopus)

摘要

Background: Various systemic immunomodulating therapies have been used to treat toxic epidermal necrolysis (TEN), but their efficacy remains unclear. Objective: To perform a systematic review and network meta-analysis (NMA) evaluating the effects of systemic immunomodulating therapies on mortality for Stevens-Johnson syndrome (SJS)/TEN overlap and TEN. Methods: A literature search was performed in online databases (from inception to October 31, 2019). Outcomes were mortality rates and Score of Toxic Epidermal Necrolysis (SCORTEN)–based standardized mortality ratio (SMR). A frequentist random-effects model was adopted. Results: Sixty-seven studies involving 2079 patients were included. An NMA of 10 treatments showed that none was superior to supportive care in reducing mortality rates and that thalidomide was associated with a significantly higher mortality rate (odds ratio, 11.67; 95% confidence interval [CI], 1.42-95.96). For SMR, an NMA of 11 treatment arms showed that corticosteroids and intravenous immunoglobulin combination therapy was the only treatment with significant survival benefits (SMR, 0.53; 95% CI, 0.31-0.93). Limitations: Heterogeneity and a paucity of eligible randomized controlled trials. Conclusions: Combination therapy with corticosteroids and IVIg may reduce mortality risks in patients with SJS/TEN overlap and TEN. Cyclosporine and etanercept are promising therapies, but more studies are required to provide clearer evidence.

原文英語
頁(從 - 到)390-397
頁數8
期刊Journal of the American Academy of Dermatology
84
發行號2
DOIs
出版狀態接受/付印 - 2020

ASJC Scopus subject areas

  • 皮膚科

指紋

深入研究「Treating toxic epidermal necrolysis with systemic immunomodulating therapies: A systematic review and network meta-analysis」主題。共同形成了獨特的指紋。

引用此