Original articleTreating toxic epidermal necrolysis with systemic immunomodulating therapies: A systematic review and network meta-analysis
Section snippets
Methods
This NMA was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) extension guidelines (Supplemental Table I; available via Mendeley at https://doi.org/10.17632/4b3cd3d53x.1).14
Search results and trial characteristics
Sixty-seven studies involving 2079 patients with SJS/TEN overlap and TEN met the inclusion criteria (Supplemental Fig 1; available via Mendeley at https://doi.org/10.17632/4b3cd3d53x.1). A summary of the trial characteristics is presented in Supplemental Table II, A and B (available via Mendeley at https://doi.org/10.17632/4b3cd3d53x.1). Two of the 67 studies showed partially duplicated data; therefore, only 66 studies were included for NMA. Most of the included studies were retrospective
Discussion
This NMA showed that none of the included SITs reduced MRs in patients with SJS/TEN overlap and TEN. However, in the analysis based on SMR, combination therapy with corticosteroids and IVIg significantly reduced the observed mortality risks. Because the range of predicted mortality of patients with SJS, SJS/TEN overlap, and TEN is extremely wide (from 3.2% to 90%), analysis using SMR can account for the baseline severity of the disease, thus reflecting a more accurate treatment response.
Conclusions
In conclusion, this NMA showed that combination therapy with corticosteroids and IVIg may lower mortality risks in patients with SJS/TEN and TEN. Some other treatments (cyclosporine, cyclosporine combined with IVIg, IVIg combined with plasmapheresis, and ETN) are potential effective treatment options but require more evidence. Further studies, such as RCTs, are required to fill the gap in scientific evidence in treating this life-threatening adverse drug reaction.
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Cited by (0)
Drs Tu and Huang contributed equally to this article.
Funding sources: None.
Conflicts of interest: None disclosed.
IRB approval status: Not applicable.
Reprints not available from the authors.