The efficacy of intravenous immunoglobulin for the treatment of toxic epidermal necrolysis: a systematic review and meta-analysis.

Abstract

BACKGROUND:

Quantitative analysis of intravenous immunoglobulin (IVIg) treatment against toxic epidermal necrolysis (TEN) is lacking.

OBJECTIVES:

To provide a meta-analysis evidence-based examination of IVIg efficacy against TEN.

METHODS:

A systematic review and meta-analysis of literature published before 31 July 2011 was conducted. In observational controlled studies with at least eight patients with TEN receiving IVIg treatment, a pooled estimate of mortality risk was determined, comparing IVIg and supportive care. Statistical analyses were performed on raw data to compare the clinical differences between (i) high-dose and low-dose IVIg treatment in adult patients and (ii) paediatric and adult patients treated with IVIg.

RESULTS:

Seventeen studies met inclusion criteria. Overall mortality rate of patients with TEN treated with IVIg was 19.9%. The pooled odds ratio (OR) for mortality from six observational controlled studies comparing IVIg and supportive care was 1.00 [95% confidence interval (CI) 0.58-1.75; P=0.99]. The pooled OR for mortality in patients treated with high-dose IVIg vs. supportive care was 0.63 (95% CI 0.27-1.44; P=0.27). Adults treated with high-dose IVIg exhibited significantly lower mortality than those treated with low-dose IVIg (18.9% vs. 50%, respectively; P=0.022); however, multivariate logistic regression model adjustment indicated that IVIg dose does not correlate with mortality (high vs. low dose: OR 0.494; 95% CI 0.106-2.300; P=0.369). Paediatric patients treated with IVIg had significantly lower mortality than adults (0% vs. 21.6%; P=0.001).

CONCLUSIONS:

Although high-dose IVIg exhibited a trend towards improved mortality and children treated with IVIg had a good prognosis, the evidence does not support a clinical benefit of IVIg. Randomized controlled trials are necessary.

• Authors: Y-C Huang, Y-C Li, T-J Chen
• Journal: The British journal of dermatology (Br J Dermatol) Vol. 167 Issue 2 Pg. 424-32 (Aug 2012) ISSN: 1365-2133 [Electronic] England
• PMID: 22458671 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: © 2012 The Authors. BJD © 2012 British Association of Dermatologists.

Chemical References

• Immunoglobulins, Intravenous

Topics

• Adolescent
• Adult
• Aged
• Child
• Epidemiologic Methods
• Humans
• Immunoglobulins, Intravenous (therapeutic use)
• Length of Stay
• Middle Aged
• Stevens-Johnson Syndrome (drug therapy)
• Treatment Outcome
• Young Adult