Discontinuing Drugs Can Save Patients with TEN and SJS

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Discontinuing Drugs Can Save Patients with TEN and SJS

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), characterized by cutaneous eruptions and epidermal loss, are serious abnormal responses to drug therapy. About 30% of patients with TEN die, usually from infection or pulmonary complications. It is believed that stopping the causative drug as soon as possible can reduce the risk of death, but this has not been studied rigorously.

These authors conducted a retrospective chart review of 203 patients with SJS or TEN that did not result from graft-versus-host disease. The authors' goal was to evaluate the relation between withdrawal of the drug and risk of death. Complete data were available for 113 patients (74 with TEN), 20 of whom died. Early withdrawal was defined as stopping the causative drug on the same day that the first blister or mucosal erosion appeared. The death rate among those who stopped early was significantly lower (11% vs. 27%). Drugs with a half-life longer than 24 hours were associated with the worst prognosis, even if they were stopped early. The authors note that the decision to stop the drug is often made by the patient, rather than by the physician, or dictated by the end of a treatment regimen.

Comment: This is an important study despite the limitations of its observational, retrospective design. It confirms that the causative drug must be stopped early, or to be truly effective, immediately. Physicians should warn patients who take drugs that have the highest risk of causing SJS-TEN, such as sulfonamide antibiotics and anticonvulsants, about mucosal erosions and blisters and advise them that discontinuing the drug may be life saving. Treating physicians should also have their patients discontinue drugs that can decrease the clearance of the causative drug.

— NH Shear

Published in Journal Watch Dermatology May 1, 2000

Citation(s):

Garcia-Doval I et al. Toxic epidermal necrolysis and Stevens-Johnson syndrome: Does early withdrawal of causative drugs decrease the risk of death? Arch Dermatol 2000 Mar 136 323-327.

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