Treating toxic epidermal necrolysis with systemic immunomodulating therapies: A systematic review and network meta-analysis

Tsung Yu Tsai, I. Hsin Huang, Yuan Chen Chao, Hua Li, Tyng Shiuan Hsieh, Hsiao Han Wang, Yu Ting Huang, Chun Yuan Chen, Ying Chih Cheng, Po Hsiu Kuo, Yu Chen Huang, Yu Kang Tu

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59 Citations (Scopus)


Background: Various systemic immunomodulating therapies have been used to treat toxic epidermal necrolysis (TEN), but their efficacy remains unclear. Objective: To perform a systematic review and network meta-analysis (NMA) evaluating the effects of systemic immunomodulating therapies on mortality for Stevens-Johnson syndrome (SJS)/TEN overlap and TEN. Methods: A literature search was performed in online databases (from inception to October 31, 2019). Outcomes were mortality rates and Score of Toxic Epidermal Necrolysis (SCORTEN)–based standardized mortality ratio (SMR). A frequentist random-effects model was adopted. Results: Sixty-seven studies involving 2079 patients were included. An NMA of 10 treatments showed that none was superior to supportive care in reducing mortality rates and that thalidomide was associated with a significantly higher mortality rate (odds ratio, 11.67; 95% confidence interval [CI], 1.42-95.96). For SMR, an NMA of 11 treatment arms showed that corticosteroids and intravenous immunoglobulin combination therapy was the only treatment with significant survival benefits (SMR, 0.53; 95% CI, 0.31-0.93). Limitations: Heterogeneity and a paucity of eligible randomized controlled trials. Conclusions: Combination therapy with corticosteroids and IVIg may reduce mortality risks in patients with SJS/TEN overlap and TEN. Cyclosporine and etanercept are promising therapies, but more studies are required to provide clearer evidence.

Original languageEnglish
Pages (from-to)390-397
Number of pages8
JournalJournal of the American Academy of Dermatology
Issue number2
Publication statusPublished - Feb 2021


  • corticosteroids
  • intravenous immunoglobulin
  • network meta-analysis
  • Stevens-Johnson syndrome
  • toxic epidermal necrolysis

ASJC Scopus subject areas

  • Dermatology


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