Medications as Risk Factors of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Children: A Pooled Analysis
Medications as Risk Factors of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Children: A Pooled Analysis
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DOI：
10.1542/peds.2008-1923
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发表时间：
2009-02-01
期刊：
影响因子：
8
通讯作者：
Maison, Patrick
中科院分区：
文献类型：
--
作者：
Levi, Natacha;Bastuji-Garin, Sylvie;Maison, Patrick
objective.本研究的目的是确定药物治疗与15岁以下儿童Stevens-Johnson综合征和中毒性表皮坏死松解症风险的关系。我们使用来自2项多中心国际病例对照研究的数据进行了汇总分析：重度皮肤不良反应（SCAR）研究和在法国、德国、意大利、葡萄牙、荷兰、奥地利和以色列进行的多国重度皮肤不良反应（EuroSCAR）研究。我们选择了年龄<15岁、因Stevens-Johnson综合征、Stevens-Johnson综合征/中毒性表皮坏死松解症重叠或中毒性表皮坏死松解症住院的病例受试者，以及年龄、性别和国家匹配的医院对照。当数据不一致时，通过多变量方法估计合并的粗比值比并校正混杂因素。我们的研究包括80例病例和216例匹配的对照。抗感染药物磺胺类、苯巴比妥、卡马西平和拉莫三嗪与Stevens-Johnson综合征或中毒性表皮坏死松解症的风险密切相关。在单变量分析中，丙戊酸和非甾体类抗炎药作为一个组，对乙酰氨基酚（扑热息痛）在多变量分析中突出显示了显著的相关性。我们证实了4个先前高度怀疑的儿童Stevens-Johnson综合征/中毒性表皮坏死松解症的药物风险因素：抗感染磺胺类药物、苯巴比妥、卡马西平和拉莫三嗪。在更多意想不到的风险因素中，我们怀疑对乙酰氨基酚（扑热息痛）的使用会增加史蒂文斯-约翰逊综合征或中毒性表皮坏死松解症的风险。儿科2009; 123：e297-e304
OBJECTIVE. The aim of this study was to determine the relation of medications to the risk of Stevens-Johnson syndrome and toxic epidermal necrolysis in children < 15 years of age.METHODS. We conducted a pooled analysis by using data from 2 multicenter international case-control studies: the severe cutaneous adverse reaction (SCAR) study and the multinational severe cutaneous adverse reaction (EuroSCAR) study conducted in France, Germany, Italy, Portugal, the Netherlands, Austria, and Israel. We selected case subjects aged < 15 years, hospitalized for Stevens-Johnson syndrome, Stevens-Johnson syndrome/toxic epidermal necrolysis-overlap, or toxic epidermal necrolysis, and age-, gender-, and country-matched hospital controls. Pooled crude odds ratios were estimated and adjusted for confounding by multivariate methods when numbers permitted.RESULTS. Our study included 80 cases and 216 matched controls. Antiinfective sulfonamides, phenobarbital, carbamazepine, and lamotrigine were strongly associated with the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis. Significant associations were highlighted in univariate analysis for valproic acid and nonsteroidal antiinflammatory drugs as a group and for acetaminophen (paracetamol) in multivariate analysis.CONCLUSIONS. We confirmed 4 previously highly suspected drug risk factors for Stevens-Johnson syndrome/ toxic epidermal necrolysis in children: antiinfective sulfonamides, phenobarbital, carbamazepine, and lamotrigine. Among more unexpected risk factors, we suspect that acetaminophen (paracetamol) use increases the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis. Pediatrics 2009; 123: e297-e304