Recurrences and rechallenges of suspected drugs in epidermal necrolysis patients.

Abstract

Background: Epidermal necrolysis (EN) is a rare and severe condition, characterized by a diffuse skin and mucosal detachment and mainly induced by drugs. Literature is scarce regarding the rate of recurrences and culprit drug re-exposure.

Objectives: To assess the rate of EN recurrences as well as high notoriety drugs re-exposures in patients with EN.

Methods: We used the French Health system database and included all EN patients. Suspected drugs were assessed at EN onset. The primary outcome was the rate of EN recurrence. Secondary outcomes were high notoriety drugs re-exposure or cross exposure, i.e., exposure to a drug of the same family, after the acute stage of EN.

Results: A total of 1,203/1,440 patients (83.5%) survived the acute stage, with 27 patients (2.2% (CI95%: 1.5-3.2)) meeting the recurrence criteria. In patients with allopurinol as suspected drug, 10/77 (13.0%) were cross exposed to febuxostat, without recurrence. Similarly, in patients with carbamazepine/oxcarbazepine as suspected drug, 2/26 (7.6%) were cross exposed to lamotrigine, without recurrence. Conversely, 12/38 (31.5%) and 16/37 (43.2%) patients were respectively re-exposed to pantoprazole and esomeprazole when initially suspected, and 12/42 (28.6%) were re-exposed to amoxicillin. Only one recurrence was noted in a pantoprazole re-exposed patient.

Conclusions: Among EN patients, the rate of recurrence seems low, contrasting with several re-exposures among beta lactam antibiotics and proton pump inhibitors, when initially suspected. Although we cannot exclude that the suspected drugs were not the responsible ones for several patients, future studies should assess the possible existence of transient risk factors inducing EN.