스티븐스-존슨증후군을 유발하는 주요 의약품별 위험도에 대한 체계적 문헌고찰
A Systematic Review on the Causative Medicines for Stevens-Johnson Syndrome
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Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are immune-complex-mediatedhypersensitivity reactions that predominantly involve skin and mucous membranes. Despite the low incidence, both areconsidered medical emergencies as the mortality rate has been estimated at 30-50%. Although as many as half of casesare idiopathic, several drugs have been implicated as main cause of SJS/TEN. This review therefore aimed to identifydrugs that were potentially associated with SJS/TEN and compare the relative risk of the medications. Method: A comprehensivesearch was performed using MEDLINE, EMBASE and 5 Korean databases. We defined study drugs as nonsteroidalanti-inflammatory drugs (NSAIDs), antibiotics, antiepileptics, and allopurinol. Only epidemiologic studiesinvestigating associations between the above drugs and drug-induced SJS/TEN were included. Two reviewers independentlyselected and evaluated candidate papers and extracted odds ratios or incidence rates. Meta-analysis was performedonly for drugs that were reported from 4 or more studies. Results: We found 8 case-control studies, 3 cohortstudies and 1 RCT. The ranges of adjusted ORs were 0.6-34.0 for NSAIDs, 1.6-302.0 for antiepileptics, 0.3-10.0 forantibiotics and 1.0-187.0 for allopurinol. The drug with the highest incidence of SJS/TEN was carbamazepine (40 persons/1,000 DDD). Conclusion: Finally, the risk was highest in first 8 weeks after onset of treatment in all drugs.
Abstract
Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are immune-complex-mediatedhypersensitivity reactions that predominantly involve skin and mucous membranes. Despite the low incidence, both areconsidered medical emergencies as the mortality rate has been estimated at 30-50%. Although as many as half of casesare idiopathic, several drugs have been implicated as main cause of SJS/TEN. This review therefore aimed to identifydrugs that were potentially associated with SJS/TEN and compare the relative risk of the medications. Method: A comprehensivesearch was performed using MEDLINE, EMBASE and 5 Korean databases. We defined study drugs as nonsteroidalanti-inflammatory drugs (NSAIDs), antibiotics, antiepileptics, and allopurinol. Only epidemiologic studiesinvestigating associations between the above drugs and drug-induced SJS/TEN were included. Two reviewers independentlyselected and evaluated candidate papers and extracted odds ratios or incidence rates. Meta-analysis was performedonly for drugs that were reported from 4 or more studies. Results: We found 8 case-control studies, 3 cohortstudies and 1 RCT. The ranges of adjusted ORs were 0.6-34.0 for NSAIDs, 1.6-302.0 for antiepileptics, 0.3-10.0 forantibiotics and 1.0-187.0 for allopurinol. The drug with the highest incidence of SJS/TEN was carbamazepine (40 persons/1,000 DDD). Conclusion: Finally, the risk was highest in first 8 weeks after onset of treatment in all drugs.
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