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Assessment of Need for Improved Identification of a Culprit Drug in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis.
Li, Dayan J; Velasquez, Gustavo A; Romar, George A; Schunkert, Elisa M; Foreman, Ruth K; Divito, Sherrie J.
Afiliação
  • Li DJ; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.
  • Velasquez GA; Department of Dermatology, Stanford University School of Medicine, Stanford, California.
  • Romar GA; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.
  • Schunkert EM; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.
  • Foreman RK; Albert Einstein/Montefiore Division of Dermatology, Bronx, New York.
  • Divito SJ; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.
JAMA Dermatol ; 159(8): 830-836, 2023 08 01.
Article em En | MEDLINE | ID: mdl-37342052
ABSTRACT
Importance Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a severe hypersensitivity reaction. Identifying a culprit drug is critical for patient care, yet identification is based on clinical judgment. Data are limited on the accuracy in or approach to identifying a culprit drug.

Objective:

To evaluate patient allergy list outcomes, current approaches in identifying culprit drugs, and potential methods of improving culprit drug identification. Design, Setting, and

Participants:

This retrospective cohort study spanned 18 years (January 2000 to July 2018), was conducted at Brigham and Women's Hospital and Massachusetts General Hospital (Boston), and included patients with clinically and histologically confirmed cases of SJS/TEN overlap and TEN. Main Outcomes and

Measures:

This study descriptively analyzed potential culprits to SJS/TEN, patients' allergy lists, and currently used approaches that led to those lists. It then tested the theoretical contribution of incorporating various parameters to allergy list outcomes.

Results:

Of 48 patients (29 women [60.4%]; 4 Asian [8.3%], 6 Black [12.5%], 5 Hispanic [10.4%], and 25 White [52.1%] individuals; median age, 40 years [range, 1-82 years]), the mean (SD) number of drugs taken per patient at disease onset was 6.5 (4.7). Physicians labeled 17 patients as allergic to a single culprit drug. Comparatively, 104 drugs were added to allergy lists across all patients. Physicians' approaches relied largely on heuristic identification of high-notoriety drugs and the timing of drug exposure. Use of a vetted database for drug risk improved sensitivity. Algorithm for Drug Causality for Epidermal Necrolysis scoring was discordant in 28 cases, labeling an additional 9 drugs missed by physicians and clearing 43 drugs labeled as allergens by physicians. Human leukocyte antigen testing could have potentially affected 20 cases. Consideration of infection as a culprit was limited. Conclusions and Relevance The results of this cohort study suggest that currently used approaches to identify culprit drugs in SJS/TEN are associated with overlabeling patients allergic to likely nonculprit drugs and less commonly missed possible culprit drugs. Incorporation of a systematized unbiased approach could potentially improve culprit drug identification, although ultimately a diagnostic test is necessary.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Síndrome de Stevens-Johnson Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Síndrome de Stevens-Johnson Idioma: En Ano de publicação: 2023 Tipo de documento: Article