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A Systematic Review on the Causative Medicines for Stevens-Johnson Syndrome
Korean J Clin Pharm 2013;23(4):344-364
Published online December 30, 2013
© 2013 Korean College of Clinical Pharmacy.

Kyoung-eun Kwon Sun-Young Jung, Hyun-Joo Jung, Bong Gi Kim, and Byung-Joo Park

Korea Institute of Drug Safety and Risk Management, Seoul, Korea, Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are immune-complex-mediated hypersensitivity reactions that predominantly involve skin and mucous membranes. Despite the low incidence, both are considered medical emergencies as the mortality rate has been estimated at 30-50%. Although as many as half of cases are idiopathic, several drugs have been implicated as main cause of SJS/TEN. This review therefore aimed to identify drugs that were potentially associated with SJS/TEN and compare the relative risk of the medications. Method: A comprehensive search was performed using MEDLINE, EMBASE and 5 Korean databases. We defined study drugs as nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, antiepileptics, and allopurinol. Only epidemiologic studies investigating associations between the above drugs and drug-induced SJS/TEN were included. Two reviewers independently selected and evaluated candidate papers and extracted odds ratios or incidence rates. Meta-analysis was performed only for drugs that were reported from 4 or more studies. Results: We found 8 case-control studies, 3 cohort studies 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 for antibiotics 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.
Keywords : Adverse drug reaction, Stevens-Johnson syndrome (SJS), Toxic epidermal necrolysis (TEN), Systematic review

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