Rapid review of drug induced Stevens Johnson Syndrome case reports from 2003 to 2023: Trends among monoclonal antibodies and systemic immunosuppressant therapy.

Abstract

BackgroundDrug-induced Steven-Johnson Syndrome (SJS) is a life-threatening hypersensitivity reaction and systemic steroid immunosuppressant therapy is not universally recommended. With the changing landscape of new drugs, it is important to determine emerging trends in this severe drug induced adverse event.ObjectiveThe objectives were to examine drug induced SJS case reports published from January 1 2003 to December 31 2023 for emerging trends of drugs implicated and systemic immunosuppressant therapy administered.MethodsLiterature search was done using PubMed (MEDLINE) database with keywords and Boolean terms, "Stevens Johnson Syndrome" AND "Case Report," filtered for the time period of interest, articles available free and in English. Included case reports were only studies in which a single drug was implicated.ResultsForty-nine case reports met inclusion criteria and critical analysis of quality rated studies from moderate to strong; however, causality assessment instrument was only reported for 10 (20%) case reports. There was equal distribution by sex; patient ages ranged from 2 to 95 years and 34 (69.4%) case reports originated from countries of the Asian continent. Most common drug implicated was carbamazepine, 5 (10.2%); pembrolizumab was implicated in 4 of 9 case reports involving monoclonal antibody drugs. Thirty-seven patients (75.5%) received systemic steroid immunosuppressant therapy. Two patients (4.1%) died during the clinical course.ConclusionThe published case reports are predominately from countries known to be at higher risk of drug induced SJS and the emerging greater number of case reports implicating pembrolizumab may be an important safety concern, needing further investigation. Systemic steroid use was the preferred immunosuppressant therapy.