Clinical, Cosmetic and Investigational Dermatology (Aug 2023)
Causes of Drug-Induced Severe Cutaneous Adverse Reaction Epidermal Necrolysis (EN): An Analysis Using FDA Adverse Event Reporting System (FAERS) Database
Abstract
Weiqiang Fei,1 Jun Shen,2 Hui Cai3 1College of Nursing, Hangzhou Vocational & Technical College, Hangzhou, Zhejiang Province, People’s Republic of China; 2Nursing Department, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China; 3Nursing Department, Jiangsu Province Hospital Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, People’s Republic of ChinaCorrespondence: Weiqiang Fei, College of Nursing, Hangzhou Vocational & Technical College, 68 Xueyuan Street, Xiasha Higher Education Park, Qiantang District, Hangzhou, Zhejiang Province, 310018, People’s Republic of China, Tel/Fax +86-571-56700120, Email [email protected]: The purpose of the study is to analyze FAERS data to identify drugs associated with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), determine demographics, drug classes involved, most likely resulted in death, and highlight emerging trends in SJS/TEN reactions.Patients and Methods: We reviewed the publicly available FAERS database from 2004– 2021. Using search terms “Stevens-Johnson syndrome” or “Toxic epidermal necrolysis”, we identified the reports of SJS/TEN or SJS/TEN followed by death that might associated with specific drugs. Then the amounts and trends were counted analyzed.Results: During the study period of 2004– 2021, the Food and Drug Administration (FDA) received a total of 14,363,139 reports of adverse reactions, among which 24,976 were linked to SJS or TEN. After excluding the cases with incomplete or insufficient information on age, gender, or country of origin, the median median age of patients was 53.82 (IQR = 57.52), the females accounted for 56.59% (12,827 cases) and 8,507 (38.34%) originated in the United States. The top 50 drugs were associated with 15,149 cases (60.65%). The subsequent fatal outcome occurring in 4878 out of 24,976 cases (19.53%). Top 3 drug classes associated with SJS/TEN in FAERS were antiepileptics, non-steroidal anti-inflammatory drugs (NSAIDs) and others. Top drug classes associated with SJS/TEN deaths were antineoplastic agents and cephalosporins. Linear regression showed that the annual percentage of monoclonal antibody-related SJS/TEN reactions increased at an average rate of 0.25% (95% confidence interval: 0.18, 0.32) from 0.00% in 2004 to 4.79% in 2021, faster than any other drug class except antigout drug (allopurinol).Conclusion: By using the publicly available FAERS data, we have identified some important themes and trends in drug-related SJS/TEN reactions. Monoclonal antibodies and proton pump inhibitors are drugs with emerging trends causing SJS/TEN. Additionally, cephalosporin antibiotics have a higher mortality rate following SJS/TEN.Keywords: Stevens-Johnson syndrome, SJS, toxic epidermal necrolysis, TEN, adverse drug reactions, fatal outcome, trends
