Adalimumab combination with corticosteroid therapy for Stevens–Johnson syndrome/toxic epidermal necrolysis

Abstract

Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a severe acute mucocutaneous reactions associated with considerable mortality and poor prognosis. Corticosteroids and intravenous immunoglobulin (IVIG), as a traditional remedy, have been widely used in the treatment of SJS/TEN. Recent studies have reported the potential therapeutic benefits of tumor necrosis factor-alpha (TNF-α) antagonists on the disease. However, the optimal treatment remains unknown. This study is to compare the effectiveness and safety of TNF-α antagonist adalimumab conjunction with corticosteroid to traditional remedy on SJS/TEN. In this single-center, retrospective, observational study, we enrolled 53 SJS/TEN patients received either traditional remedy (Corticosteroids and IVIG) or a combination therapy (TNF-α antagonist conjunction with corticosteroid). The primary endpoint was duration of hospitalization and re-epithelization time, and the secondary endpoints including exposure time to high-dose steroids, and major adverse event incidence. 26 patients received traditional remedy and 27 patients received combination remedy. In comparison to traditional remedy, the combination remedy reduced the hospitalization duration (25 ± 4.7 vs. 22 ± 5.2 days; P = 0.032), re-epithelization time (19 ± 2.5 vs.17 ± 3.4 days; P = 0.019), and exposure time to high-dose steroids (18 ± 4 vs. 16 ± 2 days; P = 0.025). Obviously, TNF-α levels in the combination group showed a significant decreased on the discharge day comparing to the traditional group (3.9 ± 1.8 vs. 5.8 ± 2.2, p = 0.001). The major adverse event incidences were no significant statistically difference (P > 0.05) within 6 months of follow-up after hospital discharge, and no death happened between two groups. The combination remedy (adalimumab conjunction with corticosteroid) could be an optimal treatment to promote disease recovery without increasing adverse events and morality in SJS/TEN patients.