PMID- 19775409
OWN - NLM
STAT- MEDLINE
DCOM- 20091223
LR  - 20220409
IS  - 1365-4632 (Electronic)
IS  - 0011-9059 (Linking)
VI  - 48
IP  - 10
DP  - 2009 Oct
TI  - Combination therapy of intravenous immunoglobulin and corticosteroid in the 
      treatment of toxic epidermal necrolysis and Stevens-Johnson syndrome: a 
      retrospective comparative study in China.
PG  - 1122-8
LID - 10.1111/j.1365-4632.2009.04166.x [doi]
AB  - BACKGROUND: Toxic epidermal necrolysis (TEN) and Stevens-Johnson Syndrome (SJS) 
      are drug-induced diseases with no well-established treatments. The application of 
      corticosteroid therapy is controversial. Intravenous immunoglobulin (IVIG) 
      therapy is emerging as a promising new method for the treatment of these two 
      diseases. The efficacy of combination therapy of IVIG and corticosteroid in the 
      treatment of TEN/SJS has seldom been reported. METHODS: Sixty-five consecutive 
      patients with either TEN or SJS, admitted over a 14-year period from January 1993 
      to October 2007, were treated with corticosteroid and analyzed retrospectively 
      using SCORTEN, a severity-of-illness scoring system for TEN/SJS prognosis, to 
      evaluate efficacy. For patients admitted after January 2001, additional therapy 
      with a dose of 0.4 g/kg/day of IVIG for 5 days was applied. RESULTS: In the 45 
      patients with TEN treated without IVIG, 8.63 patients were expected to die based 
      on the SCORTEN system, but 10 deaths were observed. Standardized mortality ratio 
      (SMR) analysis [(Sigmaobserved deaths/Sigmaexpected deaths) x 100] suggested that 
      patients with TEN treated with systemic corticosteroid were 16% more likely to 
      die than those treated with routine therapy (SMR = 1.16; 95% confidence interval, 
      0.56-2.13). In the further study of combination therapy, 12 patients with TEN and 
      eight patients with SJS were admitted. There were two deaths in the TEN group and 
      one death in the SJS group, with 3.51 deaths expected on the basis of the SCORTEN 
      system. SMR analysis showed that combination therapy had a tendency to reduce the 
      mortality rate of TEN (SMR = 0.85; 95% confidence interval, 0.18-2.50). 
      Nevertheless, in both the TEN and SJS groups, the difference in mortality rate 
      between the two therapies was not statistically significant (P = 0.651 and P = 1, 
      respectively). In patients with TEN, combination therapy also reduced 
      significantly the time of arrested progression (P = 0.019) and the total 
      hospitalization time (P = 0.043), but could not reduce the time to the tapering 
      of corticosteroid (P = 0.96). In SJS patients, the times of arrested progression 
      and hospitalization were also reduced significantly (P = 0.019 and P = 0.0475, 
      respectively). Likewise, the time to the tapering of corticosteroid was not 
      reduced (P = 0.122). CONCLUSION: Combination therapy with corticosteroid and IVIG 
      exhibited a tendency to reduce the mortality rate in comparison with the solo 
      administration of corticosteroid. The decrease in the mortality rate, however, 
      was not statistically significant. Combination therapy also arrested progression 
      earlier and decreased the hospitalization time, meaning that the total dose of 
      corticosteroid may be reduced. Combination therapy, however, did not lead to 
      earlier tapering of corticosteroid. No severe adverse effects of IVIG were found 
      during treatment.
FAU - Yang, Yongsheng
AU  - Yang Y
AD  - Department of Dermatology, Affiliated Huashan Hospital, Fudan University, 
      Shanghai, China.
FAU - Xu, Jinhua
AU  - Xu J
FAU - Li, Feng
AU  - Li F
FAU - Zhu, Xiaohua
AU  - Zhu X
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - England
TA  - Int J Dermatol
JT  - International journal of dermatology
JID - 0243704
RN  - 0 (Adrenal Cortex Hormones)
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 0 (Immunologic Factors)
SB  - IM
MH  - Adolescent
MH  - Adrenal Cortex Hormones/*therapeutic use
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Child
MH  - China
MH  - Drug Therapy, Combination
MH  - Female
MH  - Humans
MH  - Immunoglobulins, Intravenous/*therapeutic use
MH  - Immunologic Factors/*therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Stevens-Johnson Syndrome/*drug therapy
MH  - Young Adult
EDAT- 2009/09/25 06:00
MHDA- 2009/12/24 06:00
CRDT- 2009/09/25 06:00
PHST- 2009/09/25 06:00 [entrez]
PHST- 2009/09/25 06:00 [pubmed]
PHST- 2009/12/24 06:00 [medline]
AID - IJD4166 [pii]
AID - 10.1111/j.1365-4632.2009.04166.x [doi]
PST - ppublish
SO  - Int J Dermatol. 2009 Oct;48(10):1122-8. doi: 10.1111/j.1365-4632.2009.04166.x.