Combination therapy: Etanercept and intravenous immunoglobulin for the acute treatment of Stevens-Johnson syndrome/toxic epidermal necrolysis

Christopher H Pham; T Justin Gillenwater; Eric Nagengast; Meghan C McCullough; David H Peng; Warren L Garner

doi:10.1016/j.burns.2018.12.018

Combination therapy: Etanercept and intravenous immunoglobulin for the acute treatment of Stevens-Johnson syndrome/toxic epidermal necrolysis

Burns. 2019 Nov;45(7):1634-1638. doi: 10.1016/j.burns.2018.12.018. Epub 2019 Aug 26.

Authors

Christopher H Pham¹, T Justin Gillenwater¹, Eric Nagengast², Meghan C McCullough², David H Peng³, Warren L Garner⁴

Affiliations

¹ Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, CA 90033, United States; Division of Plastic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Suite 415, Los Angeles, CA 90033, United States.
² Division of Plastic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Suite 415, Los Angeles, CA 90033, United States.
³ Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, CA 90033, United States; Department of Dermatology, Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Ezralow Tower, Suite 5301, Los Angeles, CA 90033, United States.
⁴ Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, CA 90033, United States; Division of Plastic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Suite 415, Los Angeles, CA 90033, United States. Electronic address: wgarner@med.usc.edu.

PMID: 31466921
DOI: 10.1016/j.burns.2018.12.018

Abstract

Background: Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is an autoimmune condition with significant morbidity and mortality.

Methods: A retrospective review was performed at a single institution. All patients admitted to the LAC+USC burn unit from May 1st 2015-January 1st 2018 with a histologic diagnosis of SJS/TEN were reviewed. Patient characteristics and outcomes were recorded. These outcomes were compared to our previously published cohort.

Results: Thirteen total consecutive SJS/TEN patients were treated with etanercept. Compared to non-etanercept treated patients, etanercept-treated patients did not experience a significant difference in mortality (15.4% vs. 10%, P=0.58), ICU days (6.9 vs. 15.1, P=0.08), length-of-stay (9.8 vs 16.4, P=0.11), or infections (38.5% vs. 57.5%, P=0.58). The standardized mortality ratio in etanercept-treated patients was 0.44 (95% CI, 0.21, 0.65). In general, etanercept-treated patients had higher SCORTENs (3 vs. 2, P=0.03) and longer delays to presentation (5.2 vs. 2.7 days, P<0.01).

Conclusions: Etanercept can be considered in the treatment of SJS/TEN patients in addition to IVIg, and supportive care in a burn unit.

Keywords: Burns; Dermatology; Plastic surgery; Stevens-Johnson syndrome; Toxic epidermal necrolysis.

MeSH terms

Adult
Aged
Allopurinol / adverse effects
Anti-Bacterial Agents / adverse effects
Anticonvulsants / adverse effects
Combined Modality Therapy
Etanercept / therapeutic use*
Female
Gout Suppressants / adverse effects
Humans
Immunoglobulins, Intravenous / therapeutic use*
Immunologic Factors / therapeutic use*
Male
Middle Aged
Retrospective Studies
Stevens-Johnson Syndrome / etiology
Stevens-Johnson Syndrome / mortality
Stevens-Johnson Syndrome / therapy*
Treatment Outcome
Young Adult

Substances

Anti-Bacterial Agents
Anticonvulsants
Gout Suppressants
Immunoglobulins, Intravenous
Immunologic Factors
Allopurinol
Etanercept