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Bataille P, Lebrun-Vignes B, Bettuzzi T, Ingen-Housz-Oro S, Hadj-Rabia S, Welfringer-Morin A, Bodemer C. Drugs associated with epidermal necrolysis in children: A World Health Organization pharmacovigilance database analysis. J Eur Acad Dermatol Venereol 2024. [PMID: 38682703 DOI: 10.1111/jdv.20054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/11/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare life-threatening mucocutaneous reactions most often induced by drugs. To date, no large pharmacovigilance study has been conducted in the paediatric population. OBJECTIVES To describe the spectrum of drugs associated with SJS-TEN in children through the analysis of cases reported in the WHO pharmacovigilance database (VigiBase). METHODS Disproportionality study using data from VigiBase. All paediatric (age under 18 years) cases reported between January 1, 1967, and July 6, 2022, were included. For each molecule, a case-non-case study was performed to assess a potential pharmacovigilance signal by computing the lower end of the 95% credibility interval for the information component (IC025). We performed sensitivity analyses, (i) taking into account only cases reported by physicians and (ii) taking into account only cases reported in the last 10 years. RESULTS Among 31,376,783 adverse drug reactions reported in VigiBase, 2,248,727 were paediatric cases and 7342 were encoded as paediatric SJS-TEN. Significant statistical pharmacovigilance signals were observed for 165 drugs. The two most represented drug classes were antiepileptics and anti-infectious drugs. The five drugs with the highest IC025 were lamotrigine (IC025 4.99), carbamazepine (IC025 4.88), phenobarbital (IC025 4.67), phenytoin (IC025 4.52) and nimesulide (IC025 4.23). Acetaminophen was significantly associated with paediatric SJS-TEN (IC025 2.85) and we also described various new suspected drugs. Vaccines had no significant pharmacovigilance signal. These results were confirmed with the sensitivity analyses. CONCLUSIONS This study updates the spectrum of drugs potentially associated with paediatric SJS-TEN.
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Affiliation(s)
- Pauline Bataille
- Department of Pediatric Dermatology, Hôpital Necker-Enfants Malades Hospital, APHP, Paris City University, Paris, France
- Reference Center of Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
- Paris City University, Imagine Institute, Data Science Platform, INSERM UMR 1163, Paris, France
| | - Benedicte Lebrun-Vignes
- Reference Center of Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France
- Regional Pharmacovigilance Center, Department of Pharmacology, AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France
- Université Paris Est Créteil EpidermE, UPEC, Créteil, France
| | - Thomas Bettuzzi
- Reference Center of Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France
- Regional Pharmacovigilance Center, Department of Pharmacology, AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France
- Université Paris Est Créteil EpidermE, UPEC, Créteil, France
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Saskia Ingen-Housz-Oro
- Reference Center of Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France
- Université Paris Est Créteil EpidermE, UPEC, Créteil, France
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Smail Hadj-Rabia
- Department of Pediatric Dermatology, Hôpital Necker-Enfants Malades Hospital, APHP, Paris City University, Paris, France
- Reference Center of Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France
| | - Anne Welfringer-Morin
- Department of Pediatric Dermatology, Hôpital Necker-Enfants Malades Hospital, APHP, Paris City University, Paris, France
- Reference Center of Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France
| | - Christine Bodemer
- Department of Pediatric Dermatology, Hôpital Necker-Enfants Malades Hospital, APHP, Paris City University, Paris, France
- Reference Center of Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France
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Pakkir Maideen NM, Barakat IR, Jumale AH. Paracetamol (Acetaminophen)-associated SJS, TEN, AGEP, and DRESS Syndromes - A Narrative Review. Curr Drug Saf 2024; 19:218-223. [PMID: 37151075 DOI: 10.2174/1574886318666230505144014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/08/2023] [Accepted: 03/29/2023] [Indexed: 05/09/2023]
Abstract
INTRODUCTION Paracetamol (Acetaminophen) is a very common OTC drug that is found in more than 200 OTC products sold as pain, cough and cold remedies. Paracetamol is commonly used as an antipyretic to reduce fever and as an alternative to Non-steroidal anti-inflammatory drugs (NSAIDs) that are contraindicated in certain patients to relieve mild-moderate pain. OBJECTIVE This review article focuses on SJS, TEN, SJS/TEN overlap, AGEP, and DRESS syndromes associated with the use of paracetamol or paracetamol-containing products. METHODS To find published articles relevant to paracetamol-associated SJS, TEN, AGEP, and DRESS, we searched the online databases Medline/Pubmed/PMC, Google Scholar, Science Direct, Ebsco, Scopus, Web of Science, Embase, and reference lists using keywords like Stevens-Johnson Syndrome, Acetaminophen, Paracetamol, Toxic epidermal necrolysis, Acute generalized exanthematous pustulosis, Drug reaction with eosinophilia and systemic symptoms. RESULTS The paracetamol-associated SJS, TEN, SJS/TEN overlap, AGEP, and DRESS syndromes have been identified by a number of publications. CONCLUSION When evaluating drug-induced hypersensitivity skin reactions, healthcare professionals, including prescribers, pharmacists, and others, should be aware of this rare risk. Patients who exhibit signs and symptoms of paracetamol-associated hypersensitivity should be referred to physicians by pharmacists for further treatment. At the first sign of a skin rash or other hypersensitivity reaction while taking paracetamol, patients should be told to stop taking it and see a doctor right away.
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Affiliation(s)
| | | | - AbduRazak Hassan Jumale
- Department of Medical Affairs, Dubai Academic Health Corporation/Dubai Health Authority, Dubai, UAE
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Jin Y, Yu X, Li J, Su M, Li X. Causal effects and immune cell mediators between prescription analgesic use and risk of infectious diseases: a Mendelian randomization study. Front Immunol 2023; 14:1319127. [PMID: 38193081 PMCID: PMC10772142 DOI: 10.3389/fimmu.2023.1319127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction Clinical observations have found that prolonged use of analgesics increases the incidence of infection. However, the direct causal relationship between prescription analgesic use (PAU) and risk of infection (ROI) remains unclear. Methods This study used Mendelian randomization (MR) design to estimate the causal effect of PAU on ROI, as well as their mediating factors. Genetic data on prescription analgesics use and immune cells were obtained from published GWAS. Additionally, data on ROI were extracted from the FinnGen database. Two-sample MR analysis and multivariate MR (MVMR) analysis were performed using inverse variance weighting (IVW) to ascertain the causal association between PAU and ROI. Finally, 731 immune cell phenotypes were analyzed for their mediating role between analgesics and infection. Results Using two-sample MR, IVW modeling showed that genetically predicted opioid use was associated with increased risk of pulmonary infection (PI) (OR = 1.13, 95% CI: 1.05-1.21, p< 0.001) and upper respiratory infection (URI) (OR = 1.18, 95% CI: 1.08-1.30, p< 0.001); non-steroidal anti-inflammatory drugs (NSAIDs) were related to increased risk of skin and subcutaneous tissue infection (OR = 1.21, 95% CI: 1.05-1.39, p = 0.007), and antimigraine preparations were linked to a reduced risk of virus hepatitis (OR = 0.79, 95% CI: 0.69-0.91, p< 0.001). In MVMR, the association of opioids with URI and PI remained after accounting for cancer conditions. Even with a stricter threshold (p< 0.05/30), we found a significant causal association between opioids and respiratory infections (URI/PI). Finally, mediation analyses found that analgesics influence the ROI through different phenotypes of immune cells as mediators. Conclusion This MR study provides new genetic evidence for the causal relationship between PAU and ROI, and the mediating role of immune cells was demonstrated.
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Affiliation(s)
- Yi Jin
- The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Pharmacy, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
| | - Xinghao Yu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, China
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Jun Li
- The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Pharmacy, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
| | - Mingzhu Su
- The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
- Department of Pharmacy, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
| | - Xiaomin Li
- The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Pharmacy, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
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Demouche S, Bettuzzi T, Sbidian E, Laugier Castellan D, Osmont MN, Ingen-Housz-Oro S, Lebrun-Vignes B. Reality of drug-induced erythema multiforme: A French pharmacovigilance study. Therapie 2023; 78:711-719. [PMID: 37024401 DOI: 10.1016/j.therap.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/08/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Since the 2002 SCAR study, erythema multiforme (EM), a post-infectious disease, has been distinguished from Stevens-Johnson syndrome (SJS), drug-induced. Nevertheless, EM cases are still reported in the French pharmacovigilance database (FPDB). OBJECTIVES To describe EM reported in the FPDB and to compare the quality and the characteristics of the reports. METHODS This retrospective observational study selected all EM cases reported in the FPDB over two periods: period 1 (P1, 2008-2009) and period 2 (P2, 2018-2019). Inclusion criteria were 1) a diagnosis of clinically typical EM and/or validated by a dermatologist; 2) a reported date of onset of the reaction; and 3) a precise chronology of drug exposure. Cases were classified confirmed EM (typical acral target lesions and/or validation by a dermatologist) and possible EM (not-otherwise-specified target lesions, isolated mucosal involvement, doubtful with SJS). We concluded possible drug-induced EM when EM was confirmed, with onset ranging from 5 to 28 days without an alternative cause. RESULTS Among 182 selected reports, 140 (77%) were analyzed. Of these, 67 (48%) presented a more likely alternative diagnosis than EM. Of the 73 reports of EM cases finally included (P1, n=41; P2, n=32), 36 (49%) had a probable non-drug cause and 28 (38%) were associated with only drugs with an onset time ≤4 days and/or ≥29 days. Possible drug-induced EM was retained in 9 cases (6% of evaluable reports). Etiological work-up was more often performed in period 2 than 1 (53.1% vs 29.3%, P=0.04), and the time to onset from 5 to 28 days was more frequent in period 2 (59.2% vs 40%, P=0.04). CONCLUSIONS This study suggests that possible drug-induced EM is rare. Many reports describe "polymorphic" rashes inappropriately concluded as EM or post-infectious EM with unsuitable drug accountability subject to protopathic bias.
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Affiliation(s)
- Sarah Demouche
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France
| | - Thomas Bettuzzi
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France; Université Paris-Est Créteil, EpiDermE, 94000 Créteil, France
| | - Emilie Sbidian
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France; Université Paris-Est Créteil, EpiDermE, 94000 Créteil, France
| | - Delphine Laugier Castellan
- Centre régional de pharmacovigilance Marseille - Provence - Corse, hôpital Sainte-Marguerite, AP-HM, 13005 Marseille, France
| | - Marie-Noelle Osmont
- Centre régional de pharmacovigilance de Rennes, CHRU hôpital Pontchaillou, 35000 Rennes, France
| | - Saskia Ingen-Housz-Oro
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France; Université Paris-Est Créteil, EpiDermE, 94000 Créteil, France; Reference center for toxic bullous diseases and severe drug reactions TOXIBUL, 94000 Créteil, France.
| | - Bénédicte Lebrun-Vignes
- Université Paris-Est Créteil, EpiDermE, 94000 Créteil, France; Reference center for toxic bullous diseases and severe drug reactions TOXIBUL, 94000 Créteil, France; Centre régional de Pharmacovigilance - hôpital Pitié-Salpêtrière GH, Sorbonne université, AP-HP, 75000 Paris, France
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Spillers NJ, Luther PM, Talbot NC, Ly GH, Downs EM, Lavespere G, Pavlickova D, Ahmadzadeh S, Viswanath O, Varrassi G, Shekoohi S, Kaye AD. Association of Acetaminophen With Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Pharmacologic Considerations and Treatment Options. Cureus 2023; 15:e41116. [PMID: 37519510 PMCID: PMC10382713 DOI: 10.7759/cureus.41116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Acetaminophen is an extremely common drug with many implications for its analgesic and antipyretic properties. It has a unique mechanism of action and downstream effects that separate it categorically from non-steroidal anti-inflammatory drugs. These differences come with potential adverse effects that range from mild drug reactions to severe life-threatening emergencies. While acetaminophen's toxic liver effects are well known, a lesser-known adverse effect of this drug is its association with the development of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). These dermatological emergencies involve similar pathological processes, including apoptosis of the epidermis and sloughing of the dermis and mucosa from the underlying layers with a positive Nikolsky sign. Currently, SJS and TEN are considered immune-mediated type IV hypersensitivity reactions predominantly involving CD8+ T lymphocytes. Other immune mediators, including regulatory T cells, natural killer cells, interleukins, and drug metabolites are speculated to be involved, but their mechanisms have not been entirely determined. These conditions are differentially diagnosed by the percentage of body area affected with SJS and TENS, involving <10% and >30%, respectively. Genomic variations in human leukocyte antigens (HLA) genes have been implicated in the susceptibility and severity of acetaminophen-induced SJS/TENS, however, details of these interactions remain unclear. Acetaminophen's widespread use and the morbidity of its associated skin pathologies SJS and TENS warrant an in-depth examination of the causative processes involved in their pathogenesis. It is critical that both physicians and patients be made aware that while acetaminophen is widely tolerated by most individuals, severe and potentially fatal interactions do occur, and further investigation is necessary to reduce these adverse effects.
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Affiliation(s)
- Noah J Spillers
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Patrick M Luther
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Norris C Talbot
- Radiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Gianni H Ly
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Evan M Downs
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Gabriel Lavespere
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Denisa Pavlickova
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Shahab Ahmadzadeh
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Omar Viswanath
- Pain Management, Valley Pain Consultants - Envision Physician Services, Phoenix, USA
| | | | - Sahar Shekoohi
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Alan D Kaye
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
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Management of Drug-Induced Epidermal Necrolysis (DEN) in Pediatric Patients: Moving from Drug-Induced Stevens-Johnson Syndrome, Overlap and Toxic Epidermal Necrolysis to a Single Unifying Diagnosis of DEN. Paediatr Drugs 2022; 24:307-319. [PMID: 35676614 DOI: 10.1007/s40272-022-00515-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
Pediatric Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but life-threating blistering diseases triggered by medications that affect the skin and mucosae. Drug-induced epidermal necrolysis is a better term for medication-triggered cases because there is a spectrum of disease severity that otherwise is divided into the separate entities of SJS, overlap SJS/TEN, and TEN. This manuscript reviews the management of drug-induced epidermal necrolysis (DEN), including diagnosis, investigations to exclude differential diagnoses, and treatment. Diagnosis of DEN relies on clinical features and a detailed medication history. The primary differential diagnosis is reactive infectious mucocutaneous eruption, which can be clinically distinguished by its disproportionate mucous membrane involvement relative to (sparse or absent) skin lesions. Identification and discontinuation of culprit medications is the mainstay of treatment of DEN. Early initiation of immunomodulatory therapy may prevent progression, reducing maximal disease severity and the risk of sequelae. A checklist approach to detailed management of DEN is proposed.
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Prosty C, Copaescu AM, Gabrielli S, Mule P, Ben-Shoshan M. Pediatric Drug Allergy. Immunol Allergy Clin North Am 2022; 42:433-452. [DOI: 10.1016/j.iac.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Bettuzzi T, Ingen-Housz-Oro S, Maison P, de Prost N, Wolkenstein P, Lebrun-Vignes B, Sbidian E. Biases associated with epidermal necrolysis reporting in pharmacovigilance: An exploratory analysis using World Health Organization VigiBase. Pharmacoepidemiol Drug Saf 2021; 31:434-441. [PMID: 34907614 DOI: 10.1002/pds.5399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 11/25/2021] [Accepted: 12/08/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Possible biases in pharmacovigilance reporting may impact epidermal necrolysis (EN) and drugs associations. OBJECTIVES To assess biases associated with EN-reporting. METHODS Using VigiBase, the World Health Organization-pharmacovigilance database, among drugs associated with EN between 2016 and 2020, we used an unsupervised clustering including reports characteristics, that is, reporter quality, time from drug intake to EN onset, and only one suspected drug in the report. RESULTS Among 152 drugs, three clusters were identified. Cluster 1 (n = 41) exhibited drugs frequently reported within a time from intake to onset longer than 4 days, in 57 ± 13% of reports. It corresponded to well-reported drugs and was composed mainly of antivirals and antiepileptics. Cluster 2 (n = 42) exhibited drugs frequently reported within a time from drug intake to onset shorter than 4 days, in 31 ± 12% of reports. It corresponded to drugs with a high risk of protopathic bias and was composed of nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, and antibiotics. Cluster 3 (n = 69) exhibited drugs frequently reported with an unavailable time from drug intake to reaction, in 66 ± 11% of reports, and reported by a high frequency of consumers (9 ± 9%). It corresponded to drugs reported with a high risk of classification bias, and was composed of anticancer therapies and cardiovascular drugs. CONCLUSION Protopathic and classification biases impact EN-reporting and should be considered regarding associations with antibiotics, NSAIDs, analgesics, anticancer therapies, and cardiovascular drugs.
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Affiliation(s)
- Thomas Bettuzzi
- Service de Dermatologie, AP-HP, Hôpital Henri Mondor, Créteil, France.,EpiDermE, Univ Paris Est Créteil, Créteil, France
| | - Saskia Ingen-Housz-Oro
- Service de Dermatologie, AP-HP, Hôpital Henri Mondor, Créteil, France.,EpiDermE, Univ Paris Est Créteil, Créteil, France.,Centre de Référence des Dermatoses Bulleuses Toxiques et Toxidermies Graves TOXIBUL, Hôpital Henri Mondor, Créteil, France
| | - Patrick Maison
- EpiDermE, Univ Paris Est Créteil, Créteil, France.,Direction Générale, ANSM, Saint-Denis, France
| | - Nicolas de Prost
- Centre de Référence des Dermatoses Bulleuses Toxiques et Toxidermies Graves TOXIBUL, Hôpital Henri Mondor, Créteil, France.,Service de Réanimation Médicale, AP-HP, Hôpital Henri Mondor, Créteil, France
| | - Pierre Wolkenstein
- Service de Dermatologie, AP-HP, Hôpital Henri Mondor, Créteil, France.,EpiDermE, Univ Paris Est Créteil, Créteil, France.,Centre de Référence des Dermatoses Bulleuses Toxiques et Toxidermies Graves TOXIBUL, Hôpital Henri Mondor, Créteil, France
| | - Bénédicte Lebrun-Vignes
- EpiDermE, Univ Paris Est Créteil, Créteil, France.,Centre de Référence des Dermatoses Bulleuses Toxiques et Toxidermies Graves TOXIBUL, Hôpital Henri Mondor, Créteil, France.,Centre Régional de Pharmacovigilance, Service de Pharmacologie Clinique, Hôpital Pitié-Salpétrière, AP-HP, Paris, France
| | - Emilie Sbidian
- Service de Dermatologie, AP-HP, Hôpital Henri Mondor, Créteil, France.,EpiDermE, Univ Paris Est Créteil, Créteil, France.,Centre d'Investigation Clinique 1430, INSERM, Créteil, France
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Totsuka M, Watanabe T, Takamura N, Watanabe Y, Kumamoto T, Honda Y, Yoneda M, Saito S, Yamanaka S, Aihara M. A pediatric case of Stevens-Johnson syndrome with acute liver failure, resulting in liver transplantation. J Dermatol 2021; 48:1423-1427. [PMID: 34018633 DOI: 10.1111/1346-8138.15963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 12/28/2022]
Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are fatal adverse skin reactions characterized by high fever, epidermal detachment, and mucositis. It is well known that SJS/TEN occasionally affects various organs, leading to permanent damage and death in some patients. Although acute liver dysfunction is a relatively common complication of SJS/TEN, severe acute liver dysfunction requiring liver transplantation is rare. We present the case of a 14-year-old girl with SJS complicated by severe and rapidly progressive liver dysfunction, specifically, acute liver failure (ALF) requiring liver transplantation. A lymphocyte transformation test showed positive results for acetaminophen and cefdinir. Furthermore, human leukocyte antigen (HLA) genotyping revealed the presence of the HLA-A*02:06 genotype, which is reported to be strongly associated with acetaminophen-related SJS/TEN with severe ocular complications. These results suggested that our patient may have presented with acetaminophen-induced SJS complicated by ALF, but no ocular complications. This is the first report of a pediatric patient with SJS who required liver transplantation. In rare instances, severe liver dysfunction requiring liver transplantation should be considered as a possible complication of SJS/TEN.
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Affiliation(s)
- Michiru Totsuka
- Department of Dermatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Tomoya Watanabe
- Department of Dermatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Naoko Takamura
- Department of Dermatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yuko Watanabe
- Department of Dermatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Takafumi Kumamoto
- Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yasushi Honda
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Masato Yoneda
- International Clinical Center for Liver Diseases, Yokohama City University, Yokohama, Japan
| | - Satoru Saito
- International Clinical Center for Liver Diseases, Yokohama City University, Yokohama, Japan
| | - Shoji Yamanaka
- Department of Pathology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Michiko Aihara
- Department of Dermatology, Yokohama City University School of Medicine, Yokohama, Japan
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Shanbhag SS, Koduri MA, Kannabiran C, Donthineni PR, Singh V, Basu S. Genetic Markers for Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis in the Asian Indian Population: Implications on Prevention. Front Genet 2021; 11:607532. [PMID: 33510770 PMCID: PMC7837290 DOI: 10.3389/fgene.2020.607532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022] Open
Abstract
This review attempts to collate all the studies performed in India or comprising a population originating from India and to find out if there is an association between the HLA (human leucocyte antigen) type of individual and development of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) subsequent to medication use. The authors performed a PubMed search of all articles published in English from 2009 to 2019 for articles that studied HLA type in patients who developed SJS/TEN after intake of a specific drug in the Asian Indian population or in individuals of Asian Indian origin. The selection criteria were satisfied by a total of 11 studies that reported HLA associations with specific drugs, which induced SJS/TEN, mainly anti-epileptic drugs, and cold medicine/non-steroidal anti-inflammatory drugs. These studies involved a small number of patients, and hence, there is limited evidence to conclude if these associations can be extrapolated to a larger population of the same ethnicity. Similar multi-center studies need to be conducted with a larger sample size to confirm these associations. This would have implications in policy making and for understanding the potential of using genetic markers as a screening tool before prescribing a drug to a patient, which might make them susceptible to developing a potentially life-threatening disease such as SJS/TEN. This is possibly the only mode of primary prevention for this potentially fatal severe cutaneous adverse drug reaction.
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Affiliation(s)
| | - Madhuri A Koduri
- Brien Holden Eye Research Centre (BHERC), L.V. Prasad Eye Institute, Hyderabad, India.,Manipal Academy of Higher Education, Manipal, India
| | - Chitra Kannabiran
- Brien Holden Eye Research Centre (BHERC), L.V. Prasad Eye Institute, Hyderabad, India.,Kallam Anji Reddy Molecular Genetics Laboratory, L.V. Prasad Eye Institute, Hyderabad, India
| | | | - Vivek Singh
- Brien Holden Eye Research Centre (BHERC), L.V. Prasad Eye Institute, Hyderabad, India.,Center for Ocular Regeneration (CORE), L.V. Prasad Eye Institute, Hyderabad, India
| | - Sayan Basu
- The Cornea Institute, L.V. Prasad Eye Institute, Hyderabad, India.,Brien Holden Eye Research Centre (BHERC), L.V. Prasad Eye Institute, Hyderabad, India.,Center for Ocular Regeneration (CORE), L.V. Prasad Eye Institute, Hyderabad, India
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11
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Rossi E, Lasagni C, Trakatelli M, Wertzberger Rowan S, Magnoni C. Acute maculopapular eruption in Covid-19 patient: A case report. Dermatol Ther 2020; 33:e13812. [PMID: 32526051 DOI: 10.1111/dth.13812] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 12/18/2022]
Abstract
We report the case of a positive COVID-19 patient who presented to our hospital for a maculopapular skin rash which appeared 7 days after the onset of COVID-19 symptoms. He was 34 years old and nothing relevant was recorded at his previous anamnesis. The patient was hospitalized for 3 days and received systemic therapy with steroid, antihistamines, tocilizumab, and hydroxicloroquine. On the third day of the hospitalization the cutaneous rash had almost completely disappeared.
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Affiliation(s)
- E Rossi
- Department of Dermatology, Head and Neck Skin Cancer Service, Modena and Reggio Emilia University, Modena, Italy
| | - C Lasagni
- Department of Dermatology, Head and Neck Skin Cancer Service, Modena and Reggio Emilia University, Modena, Italy
| | - M Trakatelli
- Second Department of Dermatology, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | | | - C Magnoni
- Department of Dermatology, Head and Neck Skin Cancer Service, Modena and Reggio Emilia University, Modena, Italy
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12
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Gomes ESR, Marques ML, Regateiro FS. Epidemiology and Risk Factors for Severe Delayed Drug Hypersensitivity Reactions. Curr Pharm Des 2020; 25:3799-3812. [PMID: 31694518 DOI: 10.2174/1381612825666191105115346] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/31/2019] [Indexed: 02/07/2023]
Abstract
Severe delayed drug hypersensitivity reactions comprise different clinical entities and can involve different immune-mediated mechanisms. Common examples are severe cutaneous adverse reactions and druginduced internal organ injuries. The incidence of such reactions is overall low but seems to be on the rise reaching numbers as high as 9 per million individuals-years in the case of SJS/TEN and DRESS. Such conditions carry an important associated morbidity, and mortality can attain 40% in SJS/TEN patients, making these hypersensitivity reactions important targets when implementing preventive measures. Several risk factors have been identified for reaction severity; some are transverse, such as older age and underlying chronic diseases. The recent advances in pharmacogenetics allowed the identification of specific populations with higher risk and permitted strategic avoidance of certain drugs being HLA-B*57:01 screening in patients initiating abacavir the best successful example. In this work, we reviewed the epidemiology of SCARs and liver/kidney/lung drug-induced immune-mediated reactions. We focus on particular aspects such as prevalence and incidence, drugs involved, mortality and risk factors.
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Affiliation(s)
- Eva S R Gomes
- Allergy and Clinical Immunology Department, Centro Hospitalar e Universitario do Porto, Porto, Portugal
| | - Maria L Marques
- Allergy and Clinical Immunology Department, Centro Hospitalar e Universitario do Porto, Porto, Portugal
| | - Frederico S Regateiro
- Allergy and Clinical Immunology Department, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal.,Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Reseach (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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13
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Imatoh T, Sai K, Saito Y. The Association Between Concurrence of Infection and the Onset of Severe Eruption or Liver Injury in Patients Using Antipyretic Analgesics: A Matched, Nested Case-Control Study. J Clin Pharmacol 2020; 60:1177-1184. [PMID: 32521061 DOI: 10.1002/jcph.1613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 03/04/2020] [Indexed: 02/05/2023]
Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrosis (TEN) or drug-induced liver injury (DILI) are severe drug-induced reactions, known as idiosyncratic drug reactions. It is believed that immune response can lead to these severe adverse drug reactions. Our previous analysis of the Japanese Spontaneous Drug Reaction database suggested that the onset of SJS/TEN and DILI was strongly associated with infection. Hence, we conducted a matched, nested case-control study to elucidate the association between concurrent infection and the onset of SJS/TEN or liver injury in patients prescribed antipyretic analgesics. We extracted 4 112 055 patients who were prescribed antipyretic analgesics between January 2014 and December 2015. Amongst them, 553 (0.01%) were diagnosed with SJS/TEN and 12 606 (0.3%) with liver injury. In a matched, nested case-control study, 131 and 2847 cases matched for SJS/TEN or liver injury, respectively. For each case, 3 controls were randomly matched with the case for age at index date and sex. In the conditional logistic regression analysis, there was a significant association between the combination of infection and antipyretic analgesics and the onset of SJS/TEN or liver injury (SJS/TEN: adjusted OR, 5.59; 95%CI, 2.01-15.51; liver injury: adjusted OR, 2.79; 95%CI, 2.24-3.46). Although it was not possible to distinguish whether the associations were caused by the infection or were a direct consequence of the antibiotic agents, our findings may help to increase awareness of the possibility of the increased onset of idiosyncratic drug reactions (SJS/TEN and liver injury) in antipyretic analgesic users because of infections.
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Affiliation(s)
- Takuya Imatoh
- Division of Medicinal Safety Science, National Institute of Health Sciences, Kanagawa, Japan
| | - Kimie Sai
- Division of Medicinal Safety Science, National Institute of Health Sciences, Kanagawa, Japan
| | - Yoshiro Saito
- Division of Medicinal Safety Science, National Institute of Health Sciences, Kanagawa, Japan
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14
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Noda A, Sakai T, Obara T, Miyazaki M, Tsuchiya M, Oyanagi G, Murai Y, Mano N. Characteristics of pediatric adverse drug reaction reports in the Japanese Adverse Drug Event Report Database. BMC Pharmacol Toxicol 2020; 21:36. [PMID: 32448369 PMCID: PMC7245855 DOI: 10.1186/s40360-020-00412-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 05/12/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There are no reports on investigations of the characteristics of adverse drug reaction (ADR) reports for pediatric patients in the Japanese Adverse Drug Event Report database (JADER) and the utility of database for drug safety surveillance in these patients. METHOD We aimed to evaluate ADR reports for pediatric patients in the JADER. We used spontaneous ADR reports included in the JADER since April 1, 2004, to December 31, 2017, which was downloaded in April 2018. In a total of 504,407 ADR reports, the number of spontaneous reports was 386,400 (76.6%), in which 37,534 (7.4%) were unknown age reports. After extraction of 27,800 ADR reports for children aged < 10 and 10-19 years, we excepted for ADR reports associated with a vaccine (n = 6355) and no-suspected drug reports (n = 86). A total of 21,359 (4.2%) reports were finally included in this analysis. RESULTS More than half of the ADR reports were for children aged < 10 years. Approximately 30% of ADR reports had multiple suspected drugs, which did not differ by age. The percentages of fatal outcomes of ADRs among patients aged < 10 and 10-19 years were 4.7 and 3.9%, respectively. The most frequently reported drug, reaction, and drug-reaction pair were oseltamivir, abnormal behavior, and oseltamivir and abnormal behavior, respectively. CONCLUSION We clarified the characteristics of ADR reports for Japanese children by using the JADER. ADR report databases, especially those for pediatric patients, are valuable pharmacovigilance tools in Japan and other countries. Therefore, a proper understanding of the characteristics of the ADR reports in the JADER is important. Additionally, potential signals for ADRs in pediatric patients should be monitored continuously and carefully.
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Affiliation(s)
- Aoi Noda
- Division of Preventive Medicine and Epidemiology, Tohoku University Tohoku Medical Megabank Organization, Sendai, Miyagi, Japan.,Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Takamasa Sakai
- Drug Informatics, Faculty of Pharmacy, Meijo University, Nagoya, Aichi, Japan
| | - Taku Obara
- Division of Preventive Medicine and Epidemiology, Tohoku University Tohoku Medical Megabank Organization, Sendai, Miyagi, Japan. .,Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan. .,Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Miyagi, Japan.
| | - Makoto Miyazaki
- Laboratory of Clinical Pharmacy, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Miyagi, Japan
| | - Masami Tsuchiya
- Laboratory of Clinical Pharmacy, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Miyagi, Japan.,Department of Pharmacy, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Gen Oyanagi
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Yuriko Murai
- Department of Clinical Pharmaceutics, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
| | - Nariyasu Mano
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Miyagi, Japan.,Laboratory of Clinical Pharmacy, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Miyagi, Japan
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15
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Uses of pharmacovigilance databases: An overview. Therapie 2020; 75:591-598. [PMID: 32169289 DOI: 10.1016/j.therap.2020.02.022] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/20/2020] [Accepted: 02/21/2020] [Indexed: 12/11/2022]
Abstract
Over the past decades, assessment of drug safety and of their benefits harms balance has been profoundly modified by the availability of large databases and computerized automated statistical approaches. Improvement of digital data storage capacity has been applied to pharmacovigilance reports. VigiBase, the international pharmacovigilance database, is now aggregating over 21 million individual case safety reports in 2020. Identification and investigation of drug safety signals - concerning notably rare and unknown adverse drug reactions - is one of the major tasks in pharmacovigilance that can be amplified by automated signal detection. Several quantitative statistical methods exist, each with its own strengths and limits. Integrating signal detection, pharmacovigilance databases can be used for a wide variety of retrospective observational studies illustrated here by concrete examples. Confirming these signals by orthogonal validation using pre-clinical platforms and prospective trials is helpful. Pharmacovigilance databases represent a considerable source of information. However, the quality of signal detection and of pharmacoepidemiology studies in the field of adverse drug reaction closely depends on the quality of the individual data recorded.
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16
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Goto T, Yamashiro A, Maruyama N, Hirano F, Nakasone T, Nishihara K. Acetaminophen‐induced atypical Stevens‐Johnson syndrome in a patient with acute oral bacterial infection: A case report and literature review. ACTA ACUST UNITED AC 2020. [DOI: 10.1002/osi2.1049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Takahiro Goto
- Department of Oral and Maxillofacial Functional Rehabilitation Graduate School of Medicine University of the Ryukyus Nishihara Okinawa Japan
| | - Atsushi Yamashiro
- Department of Dermatology Graduate School and Medicine University of the Ryukyus Nishihara Okinawa Japan
| | - Nobuyuki Maruyama
- Department of Oral and Maxillofacial Functional Rehabilitation Graduate School of Medicine University of the Ryukyus Nishihara Okinawa Japan
- Research Fellow of Japan Society for the Promotion of Science Chiyoda‐ku Tokyo Japan
| | - Fusahiro Hirano
- Department of Oral and Maxillofacial Functional Rehabilitation Graduate School of Medicine University of the Ryukyus Nishihara Okinawa Japan
| | - Toshiyuki Nakasone
- Department of Oral and Maxillofacial Functional Rehabilitation Graduate School of Medicine University of the Ryukyus Nishihara Okinawa Japan
| | - Kazuhide Nishihara
- Department of Oral and Maxillofacial Functional Rehabilitation Graduate School of Medicine University of the Ryukyus Nishihara Okinawa Japan
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17
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Chaby G, Maldini C, Haddad C, Lebrun‐Vignes B, Hemery F, Ingen‐Housz‐Oro S, Gonzalez‐Chiappe S, Wolkenstein P, Chosidow O, Mahr A, Fardet L. Incidence of and mortality from epidermal necrolysis (Stevens–Johnson syndrome/toxic epidermal necrolysis) in France during 2003–16: a four‐source capture–recapture estimate. Br J Dermatol 2019; 182:618-624. [DOI: 10.1111/bjd.18424] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2019] [Indexed: 12/14/2022]
Affiliation(s)
- G. Chaby
- EA 7379 EpiDermE Université Paris Est Créteil France
| | - C. Maldini
- Department of Internal Medicine Hôpital Saint Louis, AP‐HP Paris France
| | - C. Haddad
- EA 7379 EpiDermE Université Paris Est Créteil France
- Regional Center of Pharmacovigilance Hôpital Pitié‐Salpêtrière, AP‐HP Paris France
| | - B. Lebrun‐Vignes
- EA 7379 EpiDermE Université Paris Est Créteil France
- Regional Center of Pharmacovigilance Hôpital Pitié‐Salpêtrière, AP‐HP Paris France
| | - F. Hemery
- Department of Medical InformaticsHôpital Henri‐Mondor, AP–HP Créteil France
| | - S. Ingen‐Housz‐Oro
- EA 7379 EpiDermE Université Paris Est Créteil France
- Department of Dermatology and Reference Center for Toxic Bullous Diseases Hôpital Henri‐Mondor, AP–HP Créteil France
| | | | - P. Wolkenstein
- EA 7379 EpiDermE Université Paris Est Créteil France
- Department of Dermatology and Reference Center for Toxic Bullous Diseases Hôpital Henri‐Mondor, AP–HP Créteil France
| | - O. Chosidow
- EA 7379 EpiDermE Université Paris Est Créteil France
- Department of Dermatology and Reference Center for Toxic Bullous Diseases Hôpital Henri‐Mondor, AP–HP Créteil France
- INSERM Centre d'Investigation Clinique 1430 Créteil France
| | - A. Mahr
- Department of Internal Medicine Hôpital Saint Louis, AP‐HP Paris France
| | - L. Fardet
- EA 7379 EpiDermE Université Paris Est Créteil France
- Department of Dermatology and Reference Center for Toxic Bullous Diseases Hôpital Henri‐Mondor, AP–HP Créteil France
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18
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Roujeau JC, Dunant A, Mockenhaupt M. Epidermal Necrolysis, Ocular Complications, and "Cold Medicines". THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019. [PMID: 29525000 DOI: 10.1016/j.jaip.2017.10.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | - Ariane Dunant
- Biostatistics and Epidemiology Unit, Gustave Roussy, Villejuif, France
| | - Maja Mockenhaupt
- Department of Dermatology Universitätsklinikum/Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany
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19
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Nguyen KD, Tran TN, Nguyen MLT, Nguyen HA, Nguyen HA, Vu DH, Nguyen VD, Bagheri H. Drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in vietnamese spontaneous adverse drug reaction database: A subgroup approach to disproportionality analysis. J Clin Pharm Ther 2018; 44:69-77. [PMID: 30129156 DOI: 10.1111/jcpt.12754] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/13/2018] [Accepted: 07/25/2018] [Indexed: 12/18/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Despite the numerous studies investigating drug-induced Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), the understanding and quantitative data in developing countries remain limited. The study aimed to describe and quantify the drug-related risk of SJS/TEN in a resource-limited context using the Vietnamese spontaneous reporting database (VSRD) of adverse drug reactions. METHODS Spontaneous reports relating to medium- and late-onset severe cutaneous adverse reactions (MLOSCAR) and SJS/TEN recorded in the VSRD from 2010 to 2015 were retrospectively analysed. The demographic characteristics and drug information were described and compared between SJS/TEN and other MLOSCAR reports. The drug-induced SJS/TEN signals were estimated using subgrouped disproportionality analysis with calculation of the reporting odds ratio (ROR) and the respective 95% confidence interval (CI). RESULTS The VSRD received 2,849 MLOSCAR reports, 136 of which focus on SJS/TEN over a 6-year period. About 60% of SJS/TEN patients were male, and the majority of them were adults (mean age 42.5 ± 22.9). Up to 91.8% of drugs induced SJS/TEN within 1-28 days, and 45% SJS/TEN cases were evaluated as life-threatening. Positive signals were generated with carbamazepine (n = 25, ROR [95% CI] = 11.99 [7.07-19.92]), allopurinol (n = 15, ROR [95% CI] = 4.2 [2.20-7.59]), traditional/herbal medicines (n = 7, ROR [95% CI] = 2.76 [1.12-5.86]), colchicine (n = 4, ROR [95% CI] = 6.22 [1.69-18.72]), valproic acid (n = 3, ROR [95% CI] = 8.71 [1.89-30.19]) and meloxicam (n = 3, ROR [95% CI] = 7.09 [1.55-24.29]), which are well known for SJS/TEN. Cefixime (n = 5, ROR [95% CI] = 3.34 [1.13-8.00]) and paracetamol (n = 22, ROR [95% CI] = 5.23 [3.10-8.49]) also generated positive signals despite their popularity in Vietnam. WHAT IS NEW AND CONCLUSION This first Vietnamese population-based study has highlighted original characteristics and signals of drug-induced SJS/TEN, which are relatively consistent with other worldwide data and typical for a developing country.
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Affiliation(s)
- Khac-Dung Nguyen
- The National Centre of Drug Information and Adverse Drug Reaction Monitoring, Hanoi University of Pharmacy, Hanoi, Vietnam.,Laboratoire de Pharmacologie Médicale et Clinique (Medical and Clinical Pharmacology Laboratory), Faculté de Médecine de l'Université Paul-Sabatier (Faculty of Medicine, Paul-Sabatier University), Toulouse, France.,Centre Hospitalier Universitaire de Toulouse (Toulouse University Hospital Centre), Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Information sur le Médicament (Midi-Pyrenees Centre for Pharmacovigilance, Pharmacoepidemiology and Drug Information), UMR INSERM 1027, Toulouse, France
| | - Thuy-Ngan Tran
- The National Centre of Drug Information and Adverse Drug Reaction Monitoring, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Mai-Loan T Nguyen
- The National Centre of Drug Information and Adverse Drug Reaction Monitoring, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Hoang-Anh Nguyen
- The National Centre of Drug Information and Adverse Drug Reaction Monitoring, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Hoang-Anh Nguyen
- The National Centre of Drug Information and Adverse Drug Reaction Monitoring, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Dinh-Hoa Vu
- The National Centre of Drug Information and Adverse Drug Reaction Monitoring, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Van-Doan Nguyen
- Centre of Allergology and Clinical Immunology, Bach Mai Hospital, Hanoi, Vietnam
| | - Haleh Bagheri
- Laboratoire de Pharmacologie Médicale et Clinique (Medical and Clinical Pharmacology Laboratory), Faculté de Médecine de l'Université Paul-Sabatier (Faculty of Medicine, Paul-Sabatier University), Toulouse, France.,Centre Hospitalier Universitaire de Toulouse (Toulouse University Hospital Centre), Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Information sur le Médicament (Midi-Pyrenees Centre for Pharmacovigilance, Pharmacoepidemiology and Drug Information), UMR INSERM 1027, Toulouse, France
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20
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Rodríguez-Martín S, Martín-Merino E, Lerma V, Rodríguez-Miguel A, González O, González-Herrada C, Ramírez E, Bellón T, de Abajo FJ. Active surveillance of severe cutaneous adverse reactions: A case-population approach using a registry and a health care database. Pharmacoepidemiol Drug Saf 2018; 27:1042-1050. [PMID: 30051945 DOI: 10.1002/pds.4622] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/30/2018] [Accepted: 06/24/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE The "case-population" design has been proposed for the surveillance of rare events like Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), wherein a registry of cases is combined with sales data from the source population in order to estimate crude odds ratios (ORs). A major drawback of this method is the inability to distinguish between new and non-new users of drugs, which for the study of hypersensitivity reactions is of utmost importance. METHODS We have explored an approach in which the exposure to the drugs of interest in the source population is inferred from a primary health care database (BIFAP), which helped us to identify drug initiators among all users and additionally adjust for potential confounders. A total of 44 SJS/TEN cases from the Registry and 44 000 controls randomly sampled from BIFAP and matched with cases for index date were included. We estimated the adjusted ORs (AORs) and 95% confidence intervals (CI) of SJS/TEN associated with the new use of 13 drugs (for which we had at least two exposed cases) through a conditional logistic regression model. RESULTS AORs (95% CI) were estimated for phenytoin, 4618 (434-49112); cotrimoxazole, 1142 (163-8015); allopurinol, 160 (36-709); dexamethasone, 38 (1.33-1077); ibuprofen, 33 (8.6-124); lorazepam, 27 (5.8-124); paracetamol, 13 (2.8-62); levofloxacine, 12 (1.24-120); amoxicillin, 6.9 (1.39-35); pantoprazole, 6.5 (0.10-420); metamizole, 6.3 (0.69-57); amoxicillin clavulanic acid, 4.2 (0.53-34); and omeprazole, 1.34 (0.06-31). The inclusion of non-new users dramatically decreased the AORs for all drugs. CONCLUSIONS The case-population approach using a registry of cases and a primary health care database proved feasible and efficient for the active surveillance of SJS/TEN.
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Affiliation(s)
- Sara Rodríguez-Martín
- Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Madrid, Spain.,Department of Biomedical Sciences, University of Alcalá, Madrid, Spain.,Pharmacoepidemiology Research Group, Institute for Health Research IRYCIS, Madrid, Spain
| | - Elisa Martín-Merino
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency of Medicines and Medical Devices, Madrid, Spain
| | - Victoria Lerma
- Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Madrid, Spain.,Pharmacoepidemiology Research Group, Institute for Health Research IRYCIS, Madrid, Spain
| | - Antonio Rodríguez-Miguel
- Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Madrid, Spain.,Department of Biomedical Sciences, University of Alcalá, Madrid, Spain.,Pharmacoepidemiology Research Group, Institute for Health Research IRYCIS, Madrid, Spain
| | - Olga González
- Dermatology Department, University Hospital of Getafe, Madrid, Spain
| | | | - Elena Ramírez
- Clinical Pharmacology Department, La Paz University Hospital, Madrid, Spain
| | - Teresa Bellón
- Drug Hypersensitivity Laboratory, Institute for Health Research IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Francisco J de Abajo
- Clinical Pharmacology Unit, Príncipe de Asturias University Hospital, Madrid, Spain.,Department of Biomedical Sciences, University of Alcalá, Madrid, Spain.,Pharmacoepidemiology Research Group, Institute for Health Research IRYCIS, Madrid, Spain
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21
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Lebrun-Vignes B, Guy C, Jean-Pastor MJ, Gras-Champel V, Zenut M. Is acetaminophen associated with a risk of Stevens-Johnson syndrome and toxic epidermal necrolysis? Analysis of the French Pharmacovigilance Database. Br J Clin Pharmacol 2017; 84:331-338. [PMID: 28963996 DOI: 10.1111/bcp.13445] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 09/20/2017] [Indexed: 12/24/2022] Open
Abstract
AIM Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but severe mostly drug-induced cutaneous reactions. Acetaminophen is an over-the-counter drug used worldwide to treat pain and reduce fever. In 2013, the US Food and Drug Administration informed the public that acetaminophen was associated with a rare risk of SJS/TEN. The aim of the present retrospective study was to analyse reports of acetaminophen as a possible suspect in the development of SJS/TEN from the French Pharmacovigilance Database (FPDB). METHODS Cases of TEN/SJS with acetaminophen as a suspect drug registered in the FPDB, collected from January 2002 to December 2013, were analysed by an expert group. The algorithm of drug causality for epidermal necrolysis (ALDEN) was used as a reference tool for SJS/TEN to assess the causality of each suspect drug. RESULTS After exclusion of 16 nonvalidated cases, 112 cases (47 TEN, 51 SJS, 14 SJS/TEN overlaps) involving 574 suspected drugs (5⋅1/case) were analysed. In 80 cases, the acetaminophen ALDEN score was inferior or equal to that of other drugs, associated with a higher suspicion for causality. In 32 cases, acetaminophen had the highest score but matched with a 'very unlikely' or 'unlikely' causality in 12 cases. For the 20 remaining cases with a 'possible' or ' probable' causality, a protopathic or a confounding bias was likely in 14 cases. CONCLUSIONS After analysis of the French pharmacovigilance data using the ALDEN algorithm, we found no obvious SJS/TEN risk related to the use of acetaminophen in this large national series.
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Affiliation(s)
- Bénédicte Lebrun-Vignes
- Centre Régional de Pharmacovigilance, Hôpitaux Universitaires Pitié-Salpêtrière Charles-Foix, AP-HP, 47-83, Boulevard de l'Hôpital, 75651 Cedex 13, Paris, France
| | - Claire Guy
- Centre Régional de Pharmacovigilance, CHU - Hôpital Nord, Avenue Albert Raimond, 42055 Cedex 02, Saint-Etienne, France
| | - Marie-Josèphe Jean-Pastor
- Centre Régional de Pharmacovigilance Marseille - Provence - Corse, Hôpital Sainte-Marguerite, AP-HM, 270 Boulevard de Saint-Marguerite, 13009 Cedex 9, Marseille, France
| | - Valérie Gras-Champel
- Centre Régional de Pharmacovigilance, CHU Amiens Sud, 80054 Cedex 1, Amiens, France
| | - Marie Zenut
- Centre Régional de Pharmacovigilance, CHU - Centre de Biologie, EA 4681 PEPRADE, Université d'Auvergne, 58 Rue Montalembert -BP 69, 63003 Cedex 1, Clermont-Ferrand, France
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