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

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)...

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Detalles Bibliográficos
Autores: González Herrada, Carlos, Rodríguez Martín, Sara|||0000-0003-3539-1470, Cachafeiro, Lucía, Lerma Hambleton, Victoria Beatriz, González, Olga, Lorente, José A., Rodríguez Miguel, Antonio, González Ramos, Jessica, Roustán, Gastón, Ramírez, Elena, Bellón, Teresa, Abajo Iglesias, Francisco José de|||0000-0001-9119-8646, Therapeutic Management Working Group, Pielenred
Tipo de recurso: artículo
Fecha de publicación:2017
País:España
Institución:Universidad de Alcalá (UAH)
Repositorio:e_Buah Biblioteca Digital Universidad de Alcalá
Idioma:inglés
OAI Identifier:oai:ebuah.uah.es:10017/60279
Acceso en línea:http://hdl.handle.net/10017/60279
https://dx.doi.org/10.1016/j.jid.2017.05.022
Access Level:acceso abierto
Palabra clave:Farmacia
Pharmacy
Descripción
Sumario: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 . 0.00e0.49). The O/E analysis also showed a reduction in mortality risk (MRROE . 0.42; 95% confidence interval . 0.14e0.99). 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 . 0.21e0.80). All three approaches consistently show that CsA reduces the mortality in epidermal necrolysis patients.

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