Format

Send to

Choose Destination
J Invest Dermatol. 2017 Oct;137(10):2092-2100. doi: 10.1016/j.jid.2017.05.022. Epub 2017 Jun 17.

Cyclosporine Use in Epidermal Necrolysis Is Associated with an Important Mortality Reduction: Evidence from Three Different Approaches.

Author information

1
Dermatology Department, University Hospital of Getafe, Getafe, Madrid, Spain.
2
Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Department of Biomedical Sciences, University of Alcalá, Institute for Health Research IRYCIS, Alcalá de Henares, Madrid, Spain.
3
Burn Unit, Intensive Care Unit, La Paz University Hospital, Madrid, Spain.
4
Burn Unit, Intensive Care Unit, University Hospital of Getafe, Getafe, Madrid, Spain; Respiratory Diseases Networking Biomedical Research Centre (CibeRes), Madrid, Spain; European University of Madrid, Madrid, Spain.
5
Dermatology Department, La Paz University Hospital, Madrid, Spain.
6
Dermatology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain.
7
Clinical Pharmacology Department, La Paz University Hospital, Madrid, Spain.
8
Drug Hypersensitivity Laboratory, Institute for Health Research IdiPAZ, La Paz University Hospital, Madrid, Spain.
9
Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Department of Biomedical Sciences, University of Alcalá, Institute for Health Research IRYCIS, Alcalá de Henares, Madrid, Spain. Electronic address: francisco.abajo@uah.es.

Abstract

Several immunomodulatory agents are used in the treatment of epidermal necrolysis, but evidence of their efficacy is limited. The Autonomous Community of Madrid has two reference burn units to which all patients with epidermal necrolysis are referred. One burn unit has mostly used cyclosporine (CsA), and the other has used non-CsA therapies (mainly high-dose intravenous immunoglobulin). The allocation of patients to one or the other burn unit was mainly based on proximity, resembling a random assignment. Thus, we took advantage of this "natural experiment" to estimate the mortality risk ratio (MRR) of CsA (n = 26) compared with non-CsA (n = 16) treatment using hospital as an instrumental variable over the period from 2001 to 2015. We also computed the observed versus expected (O/E) MRR in a case series of 49 CsA-treated patients (including 23 patients from other regions treated in Madrid), and using the Score for Toxic Epidermal Necrolysis (i.e., SCORTEN) scale to estimate the expected values. The instrumental variable-based MRR of CsA versus non-CsA was 0.09 (95% confidence interval = 0.00-0.49). The O/E analysis also showed a reduction in mortality risk (MRROE = 0.42; 95% confidence interval = 0.14-0.99). We identified five other case series of CsA-treated patients providing MRROE and meta-analyzed their results. The pooled MRROE (including from this study) was 0.41 (95% confidence interval = 0.21-0.80). All three approaches consistently show that CsA reduces the mortality in epidermal necrolysis patients.

PMID:
28634032
DOI:
10.1016/j.jid.2017.05.022
[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center