title: Cyclosporine treatment for Stevens-Johnson syndrome/toxic epidermal necrolysis: Retrospective analysis of a cohort treated in a specialized referral center.
abstract: BACKGROUND
  Treatment of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) remains controversial.
  
  
  OBJECTIVE
  We sought to evaluate the impact of cyclosporine on hospital mortality in patients with SJS/TEN.
  
  
  METHODS
  All patients with SJS and TEN admitted to our center from 2011 to 2014 were treated under a standardized protocol that allowed for cyclosporine therapy if the inclusion and exclusion criteria were met. Clinical data were reviewed retrospectively. Comparative analysis was made on mortality outcomes with patients treated with cyclosporine versus what was expected based on SCORTEN.
  
  
  RESULTS
  In all, 44 patients were admitted during the study period. A total of 24 patients received cyclosporine and the remaining 20 patients were treated supportively. SCORTEN predicted 7.2 deaths and 3 were observed in the group treated with cyclosporine. In the group treated supportively, SCORTEN predicted 5.9 deaths and 6 deaths were observed. The standardized mortality ratio of SJS/TEN treated with cyclosporine was 0.42 (95% confidence interval 0.09-1.22).
  
  
  CONCLUSIONS
  Small sample size, retrospective design, and referral bias are limitations.
  
  
  CONCLUSIONS
  The use of cyclosporine may improve mortality in SJS/TEN and needs to be validated in controlled studies.
authors.affiliation: Department of Dermatology, Singapore General Hospital, Singapore; Allergy Center, Singapore General Hospital, Singapore; Duke-National University of Singapore Medical School, Singapore. Electronic address: lee.haur.yueh@singhealth.com.sg.
authors.forename: Haur Yueh
authors.initials: HY
authors.lastname: Lee
authors.affiliation: Health Services Research Unit, Division of Medicine, Singapore General Hospital, Singapore.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Fook-Chong
authors.affiliation: Department of Dermatology, Singapore General Hospital, Singapore; Duke-National University of Singapore Medical School, Singapore.
authors.forename: Hong Yi
authors.initials: HY
authors.lastname: Koh
authors.affiliation: Department of Dermatology, Singapore General Hospital, Singapore; Duke-National University of Singapore Medical School, Singapore.
authors.forename: Tharmotharampillai
authors.initials: T
authors.lastname: Thirumoorthy
authors.affiliation: Department of Dermatology, Singapore General Hospital, Singapore; Duke-National University of Singapore Medical School, Singapore.
authors.forename: Shiu Ming
authors.initials: SM
authors.lastname: Pang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002053:Burn Units; D016572:Cyclosporine / Q000627:therapeutic use*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013262:Stevens-Johnson Syndrome / Q000188:drug therapy* / Q000401:mortality
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine
keywords: SCORTEN; Stevens-Johnson syndrome; cyclosporine; toxic epidermal necrolysis