Intravenous immunoglobulin for the treatment of toxic epidermal necrolysis: A systematic review and meta-analysis

Introduction: The efficacy of intravenous immunoglobulin (IVIg) for toxic epidermal necrolysis (TEN) remains controversial, particularly for high-dose IVIg. In the present study, we conducted a SCORTE N (SCORe of Toxic Epidermal Necrosis)-based standardized mortality ratio (SMR) meta-analysis, with a focus on the efficacy of high-dose IVIg. Evidence Acquisition: A systematic review and meta-analysis of the literature published between January 01, 2000 and April 30, 2016 was conducted. Studies with >9 TEN patients receiving IVIg treatment with SCORTE N scores were included. Evidence Synthesis: Mortality rate and pooled SMR were calculated for all TEN patients and adult TEN patients receiving IVIg. Eleven studies met the inclusion criteria. The overall mortality rate of TEN patients treated with IVIg was 24.2%, with a pooled SMR of 1.00 (95% CI, 0.76-1.32; I²=0%, P=0.67). The mortality rate among adult patients treated with high-dose IVIg was 11.7%. Sub-analysis of adult patients treated with high-dose IVIg showed a pooled SMR of 0.99 (95% CI, 0.60-1.63; I²=0%, P=0.78). Conclusions: The findings of the present meta-analysis do not support the clinical benefits of IVIg for TEN, even at high-doses. Additional randomized controlled trials are required to validate this result.