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A new case series on etanercept treatment for toxic epidermal necrolysis

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  • Published:
European Journal of Dermatology

Abstract

Background

Toxic epidermal necrolysis (TEN) is a severe, potentially lethal drug reaction for which no standard treatment is available.

Objective

To describe 17 consecutive TEN patients treated with a single dose of etanercept, a TNF-alpha inhibitor.

Materials & Methods

Comorbidities and any drug treatment initiated within the previous month were recorded on admission. Patients received 50 mg etanercept in a single subcutaneous injection. The clinical severity of the disease was computed using the SCORTEN scale. The expected number of deaths was calculated based on the probability of death associated with each SCORTEN score level. Healing was defined as complete re-epithelialization. Time to healing was analysed using the Kaplan-Meier estimator.

Results

The lowest SCORTEN score was 2, and seven patients scored in the most severe risk category (i.e.=>5). A comparison between observed (2/17) vs. expected deaths (10/17) was statistically significant (p=0.012). Fifteen patients promptly responded to treatment and achieved complete re-epithelization (median time to healing: 8.5 days), without complications or side effects. The two observed deaths were due to other causes, although re-epithelization had initiated in both patients.

Conclusion

These preliminary results add to our initial observations indicating that etanercept may effectively control TEN, a potentially lethal skin condition for which there is currently no effective cure. Where funding is available, randomized controlled trials on etanercept for TEN should be conducted.

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Authors and Affiliations

  1. Dermatology Unit, “Cristo Re” General Hospital, Rome, Italy

    Andrea Paradisi

  2. Clinical Epidemiology Unit, IDI-IRCCS, FLMM, Rome, Italy

    Damiano Abeni

  3. Clinic for Dermatology and Allergology, University Hospital Marburg, Marburg, Germany

    Dario Didona

  4. Day Surgery Unit, IDI-IRCCS, FLMM, Rome, Italy

    Francesco Ricci

  5. First Dermatology Division, IDI-IRCCS, FLMM, Roma, Italy

    Flora Canzona & Biagio Didona

Authors
  1. Andrea Paradisi
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  2. Damiano Abeni
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  3. Dario Didona
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  4. Francesco Ricci
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  5. Flora Canzona
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  6. Biagio Didona
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Corresponding author

Correspondence to Andrea Paradisi.

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Acknowledgments and disclosures

Acknowledgments: the authors thank Moira Egan for editing the manuscript. Funding sources: this study was partially supported by the Progetto “Ricerca Corrente” of the Italian Ministry of Health, Rome, Italy. Conflicts of interest: none.

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Paradisi, A., Abeni, D., Didona, D. et al. A new case series on etanercept treatment for toxic epidermal necrolysis. Eur J Dermatol 30, 561–568 (2020). https://doi.org/10.1684/ejd.2020.3883

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