Practically 1 in 4 reported sufferers with Stevens-Johnson syndrome (SJS) and poisonous epidermal necrolysis (TEN) are related to antiepileptic drug publicity, in line with findings printed in JAMA Dermatology.
Though fragrant antiepileptic medication are established threat components for extreme cutaneous hostile reactions, their total contribution to SJS/TEN throughout numerous affected person populations has not been effectively quantified. Researchers carried out a scientific evaluation and meta-analysis to estimate the proportion of SJS/TEN sufferers related to antiepileptic drug publicity and to characterize the medicines mostly concerned.
The evaluation included experimental and observational research reporting patient-level implicated medication recognized by MEDLINE and Embase searches accomplished in March 2026. The researchers calculated pooled estimates utilizing random-effects fashions and explored whether or not findings differed by age group or geographic area. The first evaluation estimated the proportion of SJS/TEN diagnoses related to antiepileptic drug publicity, with extra analyses analyzing particular person antiepileptic medication most continuously implicated in these reactions.
These findings recommend fragrant [antiepileptic drugs] as main causes of SJS/TEN and assist the preferential use of nonaromatic [antiepileptic drugs], particularly in high-risk populations and when clinically acceptable.
Total, 50 retrospective observational research encompassing 4403 sufferers with individually recognized SJS/TEN drug triggers met the inclusion standards for the meta-analysis. Of the included research, 24 have been carried out in Asia, 17 in North America, 4 in Europe, 4 in Africa, and 1 in Australia.
Total, single-drug exposures accounted for 87.8% (95% CI, 83.1%-91.9%) of SJS/TEN occasions. Antiepileptic medication have been implicated in 22.9% (95% CI, 19.4%-26.4%) of all SJS/TEN occasions and 27.3% (95% CI, 23.6%-31.1%) of drug-induced occasions after excluding infections and occasions with unknown causes. Evaluation of publication bias didn’t determine proof of serious bias.
Amongst antiepileptic drug-associated occasions, fragrant antiepileptic medication accounted for 96.1% (95% CI, 92.1%-99.0%) of implicated medicines. Carbamazepine was probably the most continuously related drug, representing 39.1% (95% CI, 28.9%-49.7%) of antiepileptic drug-associated SJS/TEN circumstances, adopted by phenytoin (19.0%; 95% CI, 10.9%-28.4%) and lamotrigine (14.6%; 95% CI, 8.4%-21.8%). By comparability, nonaromatic antiepileptic medication accounted for 1.9% (95% CI, 0.4%-4.0%) of antiepileptic drug-associated occasions.
Subgroup analyses demonstrated vital variations in line with age and geographic area. The pooled proportion of antiepileptic drug-associated SJS/TEN was considerably larger amongst children than adults (34.5% vs 23.4%; P =.03). By geographic area, the best proportion was noticed in West Asia (41.9%), adopted by South Asia (34.9%), whereas Africa had the bottom proportion (10.4%; P <.001).
Meta-regression additionally confirmed that extra lately printed research reported larger proportions of antiepileptic drug-associated SJS/TEN, though publication 12 months defined solely a small quantity of between-study variability. Publication 12 months defined 5.6% of the between-study variability.
Research limitations embody the observational design of all included research, exclusion of research missing patient-level drug set off information, restricted reporting on drug causality strategies, incapability to judge SJS and TEN individually, substantial residual heterogeneity, and a scarcity of regional antiepileptic drug prescribing information.
“These findings recommend fragrant [antiepileptic drugs] as main causes of SJS/TEN and assist the preferential use of nonaromatic [antiepileptic drugs], particularly in high-risk populations and when clinically acceptable,” the examine authors concluded.
Disclosures: One examine writer declared affiliations with biotech, pharmaceutical, and/or gadget corporations. Please see the unique reference for a full record of disclosures.
