Dong Yoon Kang1, James Yun2, Suh-Young Lee3, Young-Il Koh4, Da Woon Sim4, Sujeong Kim5, Young Hee Nam6, Jung-Won Park7, Sae Hoon Kim8, Young-Min Ye9, Hye-Kyung Park10, Min-Hye Kim11, Young-Koo Jee12, Jae-Woo Jung13, Min-Suk Yang14, Sang-Heon Kim15, Jun Kyu Lee16, Cheol-Woo Kim17, Gyu Young Hur18, Mi-Yeong Kim19, Seoung Ju Park20, Yong Eun Kwon21, Jeong-Hee Choi22, Joo-Hee Kim23, Sang Hyon Kim24, Hyen O La25, Min-Gyu Kang26, Chan Sun Park27, Sang Min Lee28, Yi Yeong Jeong29, Hee-Kyoo Kim30, Hyun Jung Jin31, Jae-Won Jeong32, Jaechun Lee33, Yong Won Lee34, Seung Eun Lee35, Myoung Shin Kim36, Hye-Ryun Kang37. 1. Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea. 2. Department of Immunology and Rheumatology, Nepean Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. 3. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. 4. Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea. 5. Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea. 6. Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea. 7. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. 8. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. 9. Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea. 10. Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea. 11. Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea. 12. Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea. 13. Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea. 14. Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea. 15. Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea. 16. Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea. 17. Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea. 18. Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea. 19. Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea. 20. Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea. 21. Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea. 22. Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea. 23. Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea. 24. Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea. 25. Department of Pharmacology, Catholic University of Korea, College of Medicine, Seoul, Korea. 26. Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea. 27. Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea. 28. Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea. 29. Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea. 30. Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea. 31. Department of Internal Medicine, Medical school of Yeungnam University, Daegu, Korea. 32. Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea. 33. Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea. 34. Department of Internal Medicine, Catholic Kwandong University College of Medicine, Incheon, Korea. 35. Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea. 36. Department of Dermatology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea. 37. Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. Electronic address: helenmed@snu.ac.kr.
Abstract
BACKGROUND: Because severe cutaneous adverse reactions (SCARs), such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) rarely occur, clinical data based on large-scale studies are still lacking. OBJECTIVE: To provide information on culprit drugs and clinical characteristics, including morbidity and mortality of SCARs based on a nationwide registry. METHODS: SCAR cases that occurred from 2010 to 2015 were recruited to the Korean SCAR registry from 34 tertiary referral hospitals. Demographics, causative drugs, causality, and clinical outcomes were collected by reviewing the medical record. RESULTS: A total of 745 SCAR cases (384 SJS/TEN cases and 361 DRESS cases) due to 149 drugs were registered. The main causative drugs were allopurinol (14.0%), carbamazepine (9.5%), vancomycin (4.7%), and antituberculous agents (6.3%). A strong preference for SJS/TEN was observed in carbonic anhydrase inhibitors (100%), nonsteroidal anti-inflammatory drugs (84%), and acetaminophen (83%), whereas dapsone (100%), antituberculous agents (81%), and glycopeptide antibacterials (78%) were more likely to cause DRESS. The mortality rate was 6.6% (SJS/TEN 8.9% and DRESS 4.2%). The median time to death was 19 days and 29 days in SJS/TEN and DRESS respectively, and 89.8% of deaths occurred within 60 days after the onset of the skin symptoms. CONCLUSION: Allopurinol, carbamazepine, vancomycin, and antituberculous agents were the leading causes of SCARs in Korea. Some drugs preferentially caused a specific phenotype. The mortality rate of SCARs was 6.6%, and most of the deaths occurred within 2 months.
BACKGROUND: Because severe cutaneous adverse reactions (SCARs), such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) rarely occur, clinical data based on large-scale studies are still lacking. OBJECTIVE: To provide information on culprit drugs and clinical characteristics, including morbidity and mortality of SCARs based on a nationwide registry. METHODS: SCAR cases that occurred from 2010 to 2015 were recruited to the Korean SCAR registry from 34 tertiary referral hospitals. Demographics, causative drugs, causality, and clinical outcomes were collected by reviewing the medical record. RESULTS: A total of 745 SCAR cases (384 SJS/TEN cases and 361 DRESS cases) due to 149 drugs were registered. The main causative drugs were allopurinol (14.0%), carbamazepine (9.5%), vancomycin (4.7%), and antituberculous agents (6.3%). A strong preference for SJS/TEN was observed in carbonic anhydrase inhibitors (100%), nonsteroidal anti-inflammatory drugs (84%), and acetaminophen (83%), whereas dapsone (100%), antituberculous agents (81%), and glycopeptide antibacterials (78%) were more likely to cause DRESS. The mortality rate was 6.6% (SJS/TEN 8.9% and DRESS 4.2%). The median time to death was 19 days and 29 days in SJS/TEN and DRESS respectively, and 89.8% of deaths occurred within 60 days after the onset of the skin symptoms. CONCLUSION:Allopurinol, carbamazepine, vancomycin, and antituberculous agents were the leading causes of SCARs in Korea. Some drugs preferentially caused a specific phenotype. The mortality rate of SCARs was 6.6%, and most of the deaths occurred within 2 months.
Authors: Fiona James; Michelle S Y Goh; Effie Mouhtouris; Sara Vogrin; Kyra Y L Chua; Natasha E Holmes; Andrew Awad; Ana-Maria Copaescu; Joseph F De Luca; Celia Zubrinich; Douglas Gin; Heather Cleland; Abby Douglas; Johannes S Kern; Constance H Katelaris; Francis Thien; Sara Barnes; James Yun; Winnie Tong; William B Smith; Andrew Carr; Tara Anderson; Amy Legg; Jack Bourke; Laura K Mackay; Ar Kar Aung; Elizabeth J Phillips; Jason Trubiano Journal: BMJ Open Date: 2022-08-17 Impact factor: 3.006
Authors: Ching-Lan Cheng; Chi-Tai Yen; Chien-Chou Su; Cheng-Han Lee; Chien-Huei Huang; Yea-Huei Kao Yang Journal: Front Cardiovasc Med Date: 2022-08-11