TNF inhibition may be effective in Stevens-Johnson syndrome/toxic epidermal necrolysis

The addition of a tumor necrosis factor inhibitor to steroid therapy reduced acute stage disease duration and hospital stay in patients with Stevens-Johnson syndrome/toxic epidermal necrolysis, according to a study.

“Systemic steroid therapies for Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) have been challenged due to their limited benefits,” Suiting Ao, MD, of the department of dermatology at The First Affiliated Hospital of Sun Yat-sen University in Guangzhou, China, and colleagues wrote. “Whether additional tumor necrosis factor (TNF)-alpha inhibition provides an optimized approach remains unexplored.”

The researchers evaluated the efficacy of TNF-alpha inhibitors in combination with steroids in a cohort of 25 patients with SJS/TEN (mean age, 40.8 years; 14 women) enrolled between January 2017 and September 2021. They also sought to determine potential biomarkers that may have utility in treating this patient population.

Patients either received methylprednisolone (n = 10) or etanercept plus methylprednisolone (n = 15).

Serum levels were also measured, including granzyme B, perforin, interferon-gamma, interleukin (IL)-6, IL-15, IL-18, macrophage inflammatory protein (MIP)-1alpha, MIP-1beta and TNF-alpha.

Results showed that etanercept plus methylprednisolone yielded a significant reduction in initial steroid treatment duration compared with steroid monotherapy (P = .0036). Moreover, the combination therapy also significantly shortened acute stage disease (P = .0009), hospital stay (P = .0243) and skin re-epithelialization (P = .0105).

Both drugs were associated with significant reduction in IL-15 levels, according to the findings. However, the combination also reduced levels of IL-6 and IL-18 compared with steroid monotherapy.

A correlation between IL-15 levels and skin re-epithelialization time was reported for both the combination therapy and steroid monotherapy arms. In addition, IL-6 served as an additional indicator of disease course among patients treated with etanercept and steroid.

The researchers noted the small sample size as a limitation of the data set.

“Additional TNF-alpha inhibition to steroid treatment is effective for SJS/TEN,” they wrote.