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KMID : 1225720190110050709
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Allergy, Asthma & Immunology Research : AAIR
2019 Volume.11 No. 5 p.709 ~ p.722
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Severe Cutaneous Adverse Reactions to Antiepileptic Drugs: A Nationwide Registry-Based Study in Korea
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Park Chan-Sun
Kang Dong-Yoon
Kang Min-Gyu
Kim Su-Jeong
Ye Young-Min
Kim Sae-Hoon
Park Hye-Kyung
Park Jung-Tak
Nam Young-Hee
Yang Min-Suk
Jee Young-Koo
Jung Jae-Woo
Kim Sang-Hyon
Kim Cheol-Woo
Kim Mi-Yeong
Kim Joo-Hee
Lee Jae-Chun
Lee Jun-Gyu
Kim Sang-Hyun
La Hyen-O
Kim Min-Hye
Park Seoung-Ju
Koh Young-Il
Lee Sang-Min
Kwon Yong-Eun
Jin Hyun-Jung
Kim Hee-Kyoo
Kang Hye-Ryun
Choi Jeong-Hee
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Abstract
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Purpose: Severe cutaneous adverse reactions (SCARs), including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) to antiepileptic drug (AED), are rare, but result in significant morbidity and mortality. We investigated the major culprit drugs, clinical characteristics, and clinical course and outcomes of AED-induced SCARs using a nationwide registry in Korea.
Methods: A total of 161 patients with AED-induced SCARs from 28 referral hospitals were analyzed. The causative AEDs, clinical characteristics, organ involvements, details of treatment, and outcomes were evaluated. We compared the clinical and laboratory parameters between SJS/TEN and DRESS according to the leading causative drugs. We further determined risk factors for prolonged hospitalization in AED-induced SCARs.
Results: Carbamazepine and lamotrigine were the most common culprit drugs causing SCARs. Valproic acid and levetiracetam also emerged as the major causative agents. The disease duration and hospital stay in carbamazepine-induced SJS/TEN were shorter than those in other AEDs (P< 0.05, respectively). In younger patients, lamotrigine caused higher incidences of DRESS than other drugs (P= 0.045). Carbamazepine, the most common culprit drug for SCARs, was associated with a favorable outcome related with prolonged hospitalization in SJS (odds ratio, 0.12; 95% confidence interval, 0.02-0.63, P= 0.12), and thrombocytopenia was found to be a risk factor for prolonged hospitalization in DRESS.
Conclusion: This was the first large-scale epidemiological study of AED-induced SCARs in Korea. Valproic acid and levetiracetam were the significant emerging AEDs causing SCARs in addition to the well-known offending AEDs such as carbamazepine and lamotrigine. Carbamazepine was associated with reduced hospitalization, but thrombocytopenia was a risk factor for prolonged hospitalization. Our results suggest that the clinical characteristics and clinical courses of AED-induced SCARs might vary according to the individual AEDs.
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KEYWORD
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Antiepileptic drugs, Stevens-Johnson syndrome, toxic epidermal necrolysis
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