Efficacy of cyclosporine for the treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis: Systemic review and meta-analysis

Background Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening reactions, mainly to drug, characterized by epidermal necrosis and mucous membrane ulceration. SCORTEN-predicted mortality has been used to assess the efficacy of treatments comparing with actual mortality. Several literatures about cyclosporine have shown its ability to halt disease progression and decrease mortality. Objectives This study was aimed to provide a more evidence-based review by conducting a meta-analysis of cyclosporine for the treatment of SJS/TEN. Methods We conducted a systemic review of articles published before Jan 31, 2017. The outcomes were mortality rate and SCORTEN-based standardized mortality ratio (SMR). The pooled odds ratio (OR) and SMR ratio were analyzed from these extracted data. Results There were 7 observational controlled studies (1 historical controlled study) which met the inclusion criteria. The overall mortality rate for patients receiving cyclosporine was 7.1%. The observed mortality was significantly lower than predicted mortality in patients receiving cyclosporine (pooled SMR: 0.42; 95% CI, 0.19–0.95). The pooled estimate of ORs for 4 studies describing observed mortality in cyclosporine to intravenous immunoglobulins (IVIg) group was 0.40 (95%CI, 0.06–2.69). Comparison of SMR between cyclosporine and IVIg was presented with the pooled SMR ratio, which showed no significant difference in SMR ratio between two treatments (SMR ratio, 0.49, 95% CI, 0.08–2.89). Conclusion We have provided the first meta-analysis study regarding the efficacy on mortality of cyclosporine for treatment of SJS/TEN. From the existing research, cyclosporine has a beneficial effect on mortality. And there is a trend that cyclosporine demonstrated better survival whether in pooled OR or SMR ratio than IVIg. Due to the limitations of current studies, a double-blind randomized controlled trial is still urged.