Etanercept Combined With Corticosteroid Therapy In The Treatment Of Stevens-johnson Syndrome And Toxic Epidermal Necrolysis:A Case Series Of 23 Patients

Objective:To describe a case series of patients with SJS/TEN treated with the combination therapy of etanercept and corticosteroid in order to evaluate this therapeutic efficacy and safety.Method:We observed 23 hospitalized patients with SJS or TEN in a retrospective view at two institutions.In all cases,patients were administered etanercept and systemic corticosteroids.We documented the primary outcomes included the skin re-epithelialtime,skin-healing time,and the other clinical characteristics and laboratory test.SCORTEN,predicted mortality rates,and common or rare adverse events during treatment were also be collected.Re-epithelialization was defined as when the rash started to darkness,blistering dryness,eroded and exfoliated lesions recovery.While healing was defined as complete re-epithelialization.A time to re-epithelialization and healing curve was analyzed with the Kaplane-Meier method.Result:1.The most common offending drugs were anticonvulsants(39.1%)and antibiotics(26.1%).2.All patients promptly responded to treatment.Median time to re-epithelialization was 7.0 days while the totally healing was 13.0 days.Combination therapy could effectively facilitate the re-epithelialial and the healing time.In the corelated factors of healing time,we found phenotype(p=0.04)and SCORTEN(p=0.05)presented negative correlation with healing time.3.During the combined therapy,there were 4(17.4%)patients suffered hypertention,especially 3(75%)patients were diagnosed TEN(p=0.46).All the patients with the diagnosis of TEN suffered temporary hyperglycemia.(p=0.15).But there were no statistic significance.Conclusion:1.The combined therapy of etanercept with systemic corticosteroid is more effective in controlling the progression of epidermal exfoliation in the course of SJS/TEN,which can significantly shorten the re-epithelialization and healing time.2.Tthe patients of TEN(TBSA>30%),whose healing time after combined treatment was longer than that of mild patients(TBSA < 30%)with a small exfoliation area.3.During the treatment of TEN patients,transient hypertension and hyperglycemia are more likely to occur,but the rate of adverse events was not consistent with the dose of accumulated corticosteroids(p=0.89).