Multi-center Clinical Observation For TNF-? Antagonists In The Treatment Of Drug-induced Toxic Epidermal Necrolysis

Objective:To investigate the efficacy of TNF-? antagonists in the treatment of Toxic Epidermal Necrolysis(TEN)induced by drugs.Methods:For 22 patients of TEN,after excluding tumors and infectious diseases such as tuberculosis and viral hepatitis,all patients were treated with the recombinant human tumor necrosis factor receptor II-IgG Fc fusion protein(rhTNFR:Fc,etanercept),25mg/time(double for the first dose),subcutaneous injection,once/3 days,6?8 times in a row,with compound glycyrrhizin for anti-inflammation,protecting liver,and various symptomatic support treatments.Evaluating various indicators after treatment:clinical symptoms,hepatorenal function,DASI score of different stages,the improving situation of DAS50,DASI75 and DASI90,the level of TNF-? in peripheral blood,the level of TNF-?in blister fluid,and adverse reactions and so on.The results were statistically analyzed by SPSS23.0.Results:All the 22 patients were cured and discharged.Except for 2 cases of infection,the temperature of the remaining 20 patients were controlled within 24-60 hours after the first treatment,and returned to normal within 48-120 hours.22 patients had no new blisters within 24-48 hours after treatment,skin color changed from bright red to dark purple after 48-96 hours,and returned to normal after 2 weeks.The transaminase returned to normal within 2-4 weeks and creatinine was controlled after 3-14 days.DASI score decreased from 53.64(+8.67)before treatment to 2.05(+1.21)at 3 weeks after treatment(p<0.01),the improvement rates of DASI50,DASI75 and DASI90 at 3 weeks after treatment were 100%,100%and 90.9%(p<0.01),and the value of TNF-a in peripheral blood decreased from 33.95(+27.9)pg/ml before treatment to 2.17(+0.75)pg/ml at recovery stage(p<0.01),and from 6.4 to 338.6 pg/ml in bleb fluid before treatment,with a median of 67.7 pg/ml.The ratio of bullous fluid to peripheral blood TNF-? was 1.83-28.21.No acute adverse reactions were found during the treatment.Conclusion:TNF-? antagonist is an effective and safe drug for the treatment of Toxic Epidermal Necrolysis(TEN)induced by drugs.