Thursday, 20 Feb 2020

You are here

Severe Stevens-Johnson and Toxic Epidermal Necrolysis Syndromes May Respond to Etanercept

The Journal of Clinical Investigation reports the results of a trial wherein etanercept (ETN) was shown to be effective in treating cytotoxic T lymphocyte–mediated (CTL-mediated) severe cutaneous adverse reactions (SCARs), including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).

These rare, severe disorders are often life-threatening and may be associated with high levels of CTL-associated cytokines, chemokines, or cytotoxic proteins, including TNF-α and granulysin.

They studied 96 patients with SJS or TEN in a randomized trial of etanercept versus traditional corticosteroids.

Etanercept was shown to improved clinical outcomes and decrease the SCORTEN-based predicted mortality rate (predicted and observed rates, 17.7% and 8.3%, respectively).

Compared with corticosteroids, etanercept treated patients had a shorter median time to skin healing (14 vs 19 days, respectively; P = 0.010) and lower rates of GI hemorrhage in all SJS-TEN patients (2.6% vs. 18.2%; P = 0.03).

Etanercept was found to decrease TNF-α and granulysin levels in blister fluids and plasma (45.7%–62.5%) and increase the circulating Treg population (2-fold increase; P = 0.002).

Anti–TNF-α therapy may be and effective alternative treatment for CTL-mediated severe skin reactions.

 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Start with Anti-TNF in RA? Not So Fast

The suggestion to hit rheumatoid arthritis (RA) early and hard with biologic therapies itself took a hit in a new study.

Use of first-line etanercept (Enbrel) plus methotrexate in very early RA was not associated with a substantially higher rate of remission compared with a strategy of treat-to-target methotrexate monotherapy, a randomized open-label trial found.

Best of 2019 - The Shame Behind Adalimumab Biosimilars

JAMA has an article this week on the shift from biologic drugs to less expensive therapeutic biosimilar agents. The impact of biosimilars can be easily represented by the shift from adalimuamb - a biologic with nearly $19 billion in sales in 2018 - to any one of the four FDA approved biosimilars for adalimumab (see the daily download for slides on new adalimumab and other biosimilars).

Psoriasis Risk Increased with TNF Inhibitors in Juveniles

Children with inflammatory diseases who were treated with tumor necrosis factor (TNF) inhibitors had a higher rate of incident psoriasis than those not exposed to these biologics, a single-center retrospective study found.

The Shame Behind Adalimumab Biosimilars

JAMA has an article this week on the shift from biologic drugs to less expensive therapeutic biosimilar agents. The impact of biosimilars can be easily represented by the shift from adalimuamb - a biologic with nearly $19 billion in sales in 2018 - to any one of the four FDA approved biosimilars for adalimumab (see the daily download for slides on new adalimumab and other biosimilars).

Pain Persists Despite TNF Inhibitor Use

Control of pain in patients with rheumatoid arthritis (RA) often focuses on control of inflammation as a means to better control pain. However, a new claims data study shows that while anti-tumor necrosis factor inhibitor (TNFi) may lower the use of opioids, the reduction is nominal, suggesting that a substantial amount of pain is not adequately addressed by TNFi - a potent anti-inflammatory approach.