A COMPARATIVE EFFECTIVENESS ANALYSIS OF TOPICAL VS SYSTEMIC CORTICOSTEROIDS FOR DRESS SYNDROME

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology Pub Date : 2024-10-25 DOI:10.1016/j.anai.2024.08.067

I. Salciccioli , B. Jiang , D. Kroshinsky , A. Dominguez , Y. Zhang , K. Blumenthal

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引用次数: 0

Abstract

Introduction

Emerging observational data suggest topical corticosteroids (TS) without systemic steroids (SS) may be sufficient for the treatment of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome in certain cases. We compared outcomes for hospitalized DRESS treated with TS versus SS.

Methods

DRESS cases were identified from electronic health records, confirmed by manual chart review, and categorized by steroid therapy regimen: TS group was started on topical steroids only versus SS who were started on systemic steroids +/- topical steroids. For those who transitioned from TS to SS group, time in each treatment group was counted accordingly. We calculated discharge and mortality rates for each group. We performed Cox-proportional hazard regression to estimate hazard ratio (HR) and adjusted potential confounders using overlap weighting of the propensity score.

Results

Of 281 DRESS cases, 242 (76%) were in SS group and 78 (24%) were in TS group. In the TS group, 40 then received systemic steroids. During follow-up, 7 patients (2.9/1000 person-days) died in SS group compared to 3 (4.2/1000 person-days) in TS. The adjusted HR of mortality for SS versus TS was 0.64 (95% CI: 0.08, 5.07). The discharge rate was 82.1/1000 person-days for SS and 110.6/1000 days for TS. The adjusted HR of discharge for SS versus TS was 0.77 (95% CI: 0.53, 1.13).

Conclusion

Compared with TS, SS tends to have lower mortality and shorter duration of hospitalization, albeit non-statistically significant owing to a relatively small sample size. Our findings suggest TS without SS should be used with caution in inpatient DRESS treatment.

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局部皮质类固醇与全身皮质类固醇治疗连衣裙综合征的疗效比较分析

导言：越来越多的观察性数据表明，在某些情况下，局部皮质类固醇（TS）而非全身性类固醇（SS）可能足以治疗伴有嗜酸性粒细胞增多和全身症状的药物反应综合征（DRESS）。我们比较了使用 TS 和 SS 治疗的 DRESS 住院病例的疗效。方法从电子病历中识别 DRESS 病例，通过人工病历审查进行确认，并按类固醇治疗方案进行分类：TS组仅开始使用局部类固醇，而SS组则开始使用全身类固醇+/-局部类固醇。对于从 TS 组转入 SS 组的患者，各治疗组的时间也相应计算在内。我们计算了各组的出院率和死亡率。结果在 281 例 DRESS 病例中，SS 组有 242 例（76%），TS 组有 78 例（24%）。在 TS 组中，有 40 名患者接受了全身类固醇治疗。在随访期间，SS 组有 7 名患者死亡（2.9/1000 人天），而 TS 组有 3 名患者死亡（4.2/1000 人天）。SS组与TS组死亡率的调整后HR为0.64（95% CI：0.08，5.07）。SS 的出院率为 82.1/1000 人天，TS 为 110.6/1000 天。结论与 TS 相比，SS 的死亡率更低，住院时间更短，但由于样本量相对较小，因此无统计学意义。我们的研究结果表明，在 DRESS 住院治疗中应慎用 TS 而非 SS。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Allergy Asthma & Immunology 医学-过敏

CiteScore

6.50

自引率

6.80%

发文量

437

审稿时长

33 days

期刊介绍： Annals of Allergy, Asthma & Immunology is a scholarly medical journal published monthly by the American College of Allergy, Asthma & Immunology. The purpose of Annals is to serve as an objective evidence-based forum for the allergy/immunology specialist to keep up to date on current clinical science (both research and practice-based) in the fields of allergy, asthma, and immunology. The emphasis of the journal will be to provide clinical and research information that is readily applicable to both the clinician and the researcher. Each issue of the Annals shall also provide opportunities to participate in accredited continuing medical education activities to enhance overall clinical proficiency.