Steroid plus anti-TNF-α proven effective in SJS/TEN

23 May 2022
Steroid plus anti-TNF-α proven effective in SJS/TEN
Xander was diagnosed with Stevens-Johnson syndrome, a life-threatening skin condition in which cell death causes the skin layers to separate. Photo credit: PA REAL LIFE/ The Sun UK

The addition of antitumour necrosis factor-alpha (anti-TNF-α) to steroid treatment may help improve outcomes for patients with Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), suggest the results of a recent study.

A team of investigators assessed the efficacy of steroid plus anti-TNF-α in the treatment of SJS/TEN, as well as identified potential biomarkers, in this study. They recruited 25 patients with SJS/TEN and divided them into two groups: 10 were treated with methylprednisolone and 15 with etanercept plus methylprednisolone.

During the acute and resolution phases, the investigators measured serum levels of granzyme B, perforin, interferon-γ, interleukin (IL)-6, IL-15, IL-18, macrophage inflammatory protein 1α, macrophage inflammatory protein 1β, and TNF-α using multiplex cytokine analysis kits.

The combination therapy markedly shortened the course of the initial steroid treatment and the duration of the acute stage, hospitalization stay, and skin re-epithelialization in comparison to steroid monotherapy.

Both therapies significantly reduced IL-15 levels, but only the combination therapy decreased IL-6 and IL-18 levels. While the IL-15 level was significantly associated with skin re-epithelialization time in both groups, the IL-6 level functioned as an additional marker for the disease course in the combination therapy arm.

Of note, the study was limited by its relatively small sample size.

“Systemic steroid therapies for SJS/TEN have been challenged because of their limited benefits,” according to the investigators.

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