Abstract
Purpose :
Systemic immunomodulator (SI) use in the acute phase of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is controversial. Cyclosporine a (CsA) has been of particular recent interest. It is unknown if SIs affect acute ocular disease severity in SJS. Our study investigated the relationship of choice of SI and acute ocular severity (AOS) in SJS. We additionally observed the relationship between use of these regimens and rates of hospital service utilization including but not limited to intensive care unit (ICU) admission, ICU length of stay (LOS), and 30-day readmission.
Methods :
We performed a retrospective, observational chart review of all patients in our system with confirmed SJS by biopsy or exam by dermatology. Patients were divided by treatment regimen including: steroids; intravenous immunoglobulin; CsA; combined CsA and steroids; and supportive care. Exclusion criteria included no documentation of the acute episode. Sixty-eight patients and 130 eyes were included. Statistics were performed in R version 4.0.2. The primary outcome was post-SI AOS score. Means with standard deviations are presented for continuous and ordinal variables and frequencies for categorical variables. Generalized estimating equations and Fisher’s exact test were used to compare SI therapies on acute ocular disease (reference group was supportive care).
Results :
No significant difference in greatest AOS score post-SI administration was seen between treatment groups after controlling for initial disease severity. Significant differences in presence of toxic epidermal necrolysis and ICU admission were noted across treatment groups. Significance did not persist when comparing those receiving any SI combination that included CsA vs no CsA in the aforementioned variables. Additionally, differences in ICU LOS and 30-day readmission rates were not observed.
Conclusions :
No relationship was found between the treatment groups and mean AOS scores post-SI administration. Frequency of ICU care was significantly different across groups but not between CsA vs non-CsA groups, suggesting that CsA, versus other SIs, is more readily used across services and in varying degrees of systemic disease severity. SI regimen does not appear to correlate with acute ocular disease outcomes in this cohort. Next steps include studying the timeline and dosage of SI administration in relation to acute and chronic ocular disease in SJS.
This is a 2021 ARVO Annual Meeting abstract.