Life-Threatening Adverse Drug Reactions Likely to Recur

Larry Hand

June 04, 2014

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) may have a high risk for recurrence, possibly within a year of first occurrence, according to a research letter published in the June 4 issue of JAMA.

Because these life-threatening conditions result from allergic reactions to drugs, physicians should weigh the benefits of drug therapy against potential risks, researchers Yaron Finkelstein, MD, from the Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada, and colleagues warn. Both conditions cause upper and lower layers of skin to detach.

The researchers conducted a population-based cohort study of Ontario residents who were hospitalized for an initial episode of SJS or TEN between April 2002 and March 2011.

Of more than 13 million Ontario residents, the researchers identified 708 patients hospitalized for a first incident of SJS (n = 567) or TEN (n = 141), including 127 patients younger than 18 years. Of those, 187 (26%) were admitted to critical care or burn units. A total of 127 (17.9%) died in the hospital or within 60 days of discharge (9.0% mortality rate for SJS, 23.4% mortality rate for TEN).

During a median follow-up period of 1283 days, 42 patients (7.2% of the remaining 581) were readmitted for a subsequent episode of SJS or TEN, and 8 patients had multiple recurrences. The median time to recurrence was 315 days.

Patients who experienced recurrences were more likely to be male, live in rural areas, have index care at an academic hospital, and be significantly younger than other patients on first occurrence.

The researchers cite previous research that identified genetic predisposition to several medications, including carbamazepine, as a link to allergic reactions, as well as another article on carbamazepine and zonisamide.

The reported incidence of SJS and TEN in the general population is 1.0 to 7.2 cases per 1 million individuals per year, the researchers write, but "the observed recurrence risk in our study (>7%) is several thousand-fold higher than would be expected."

"[T]hese findings are relevant to physicians who care for patients with a history of SJS or TEN," they conclude. "Because most such episodes are drug-induced, the high risk of recurrence should be recognized, and the benefits of drug therapy weighed carefully against the potential risks. This is particularly true for drugs commonly associated with the development of these frequently fatal conditions."

This research was supported by the Canadian Institutes of Health Research, Canadian Drug Safety and Effectiveness Research Network, and the Institute for Clinical Evaluative Sciences. The authors have disclosed no relevant financial relationships.

JAMA. 2014;311:2231-2232. Extract

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