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SJS/TEN incidence rare in patients who develop DILI from same drug

A small number of Indian patients developed Stevens-Johnson syndrome or toxic epidermal necrosis from the same medication that resulted in drug-induced liver injury and showed poor long-term outcomes.  

Researchers analyzed data of 748 consecutive patients with Stevens-Johnson syndrome (SJS) or toxic epidermal necrosis (TEN) found in a drug-induced liver injury (DILI) registry from a single clinical center between 1997 and March 2015. The researchers sought to investigate any association between DILI and SJS/TEN and to determine the drugs responsible and outcomes.

Mortality rates for DILI and SJS/TEN were configured using the Roussel Uclaf Causality Assessment Method and the Algorithm for Drug Causality for Epidermal Necrolysis, according to the research.

Of the patients, 36 cases of SJS/TEN were identified during the study period. More women developed SJS/TEN (n = 19) compared with men (n = 17) and had higher mortality (61.5% vs. 38.5%). However, this was not significant, according to the research.

Various “high-risk” drugs, such as anti-epileptic agents, sulfonamides and antiretroviral drugs, were responsible for a majority of the cases of SJS/TEN. Of the patients who developed SJS/TEN, 25% were children (n = 9) and 22% had HIV (n = 8).

Thirty-sex percent of patients with SJS/TEN died (n = 13), which increased with the presence of jaundice (45.5%). Mortality was lower in children (11%) and patients with HIV (12.5%) compared with patients with both SJS/TEN and DILI.

The researchers concluded: “DILI associated with SJS/TEN is rare and associated with a high death rate, particularly in those with jaundice; however, children and [HIV]–infected individuals have a favorable outcome.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.