Funding sources The EuroSCAR study was funded by the following institutions and companies (unrestricted grants): ADIR & Cie, Bayer Pharma/AG/Vital, Boehringer Ingelheim, Cassenne, Ciba Geigy/Novartis, Cilag GmbH, Dr Willmar Schwabe, Goedecke Parke Davis, Glaxo Wellcome/GlaxoSmithKline, Hoechst AG/Hoechst Marion Roussel/Aventis, Hoffmann–La Roche, IRIS Servier, Jouveinal Lab, LEO, Lilly, MSD Sharp & Dohme, Pfizer, Rhone Poulenc Rorer, Sanofi Winthrop/Sanofi Synthelabo GmbH, Schering AG. Funding from pharmaceutical companies in France was managed through a contract with INSERM (Institut National de la Santé et de la Recherche Médicale), French Ministry of Health (PHRC AOM 98027). The RegiSCAR study was funded by grants from the European Commission (QLRT-2002–01738), GIS-Institut des Maladies Rares and INSERM (4CH09G) in France, and by a consortium of pharmaceutical companies (unrestricted grants): Bayer Vital, Boehringer-Ingelheim, Cephalon, GlaxoSmithKline, MSD Sharp and Dohme, Merck, Novartis, Pfizer, Roche, Sanofi-Aventis, Servier, Tibotec. Maja Mockenhaupt received the Else Kröner Memorial Stipendium for support of clinical research through the Else Kröner-Fresenius Foundation.
CLINICAL AND LABORATORY INVESTIGATIONS
The role of prior corticosteroid use on the clinical course of Stevens–Johnson syndrome and toxic epidermal necrolysis: a case–control analysis of patients selected from the multinational EuroSCAR and RegiSCAR studies
Article first published online: 27 AUG 2012
© 2012 The Authors. BJD © 2012 British Association of Dermatologists
British Journal of Dermatology
Volume 167, Issue 3, pages 555–562, September 2012
How to Cite
Lee, H.Y., Dunant, A., Sekula, P., Mockenhaupt, M., Wolkenstein, P., Valeyrie-Allanore, L., Naldi, L., Halevy, S. and Roujeau, J.C. (2012), The role of prior corticosteroid use on the clinical course of Stevens–Johnson syndrome and toxic epidermal necrolysis: a case–control analysis of patients selected from the multinational EuroSCAR and RegiSCAR studies. British Journal of Dermatology, 167: 555–562. doi: 10.1111/j.1365-2133.2012.11074.x
Conflicts of interest None declared.
- Issue published online: 27 AUG 2012
- Article first published online: 27 AUG 2012
- Accepted manuscript online: 28 MAY 2012 09:40AM EST
- Accepted for publication 20 May 2012
Background Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are immunologically mediated, severe cutaneous adverse reactions involving cytotoxic T cells, natural killer cells and various mediators. In large studies, up to 15% of SJS/TEN occurred in patients with chronic corticosteroid use. It is unclear if this prior exposure to corticosteroids modified the disease course.
Objectives To evaluate whether systemic corticosteroid usage prior to the onset of SJS/TEN modified the clinical course and outcome. If a disease-modifying effect is present, information from such an analysis may have implications on the therapeutic use of corticosteroids in SJS/TEN.
Methods This is a case–control study based on data collected in the EuroSCAR and RegiSCAR studies. Ninety-two cases of SJS/TEN with exposure to corticosteroids prior to the onset of disease, and 321 randomly selected SJS/TEN patients without prior exposure were included. Primary outcomes included progression of disease, disease severity and mortality. A secondary analysis of latency between the beginning of drug use and the onset of disease, based on exposure to a single high-risk drug, was also performed.
Results On multivariate analysis, cases with prior exposure to corticosteroids had a longer progression of disease by 2·2 days [95% confidence interval (CI) 1·1–3·2]. The disease severity and mortality outcome were unaffected. In addition, there is evidence that corticosteroids delayed the onset of SJS/TEN in patients with exposure to high-risk drugs by 7·1 days (CI −0·2 to 14·5).
Conclusions The prior use of corticosteroids prolonged the period of disease progression without influencing the disease severity or mortality. In addition, when SJS/TEN is preceded by use of a single high-risk drug, the latency between the drug intake and the onset of SJS/TEN may also be increased. These findings suggest that corticosteroids have a mild impact on the course of SJS/TEN, and further studies are required to clarify any potential therapeutic effects.