Treatment of epidermal necrolysis with high-dose intravenous immunoglobulins (IV Ig): clinical experience to date

Abstract

High-dose human intravenous immunoglobulins (IV I ) have now been used as a treatment for epidermal necrolysis for several years. We have reviewed all series involving more than nine patients treated with high-dose IV Ig for toxic epidermal necrolysis (TEN) or Stevens-Johnson syndrome (SJS) published in indexed journals. Nine series included a total of 156 patients; among the 156 reported cases, 32 patients died (20.5%). When the analysis was restricted to the five series that included some comparison with expected deaths, the mortality rate observed in patients treated with IV Ig was 27% versus an expected rate of 30%. Because of high diversity in study designs and dosages of IV Ig used, and because several series included duplicate cases, it was not possible to make more detailed statistical analyses, including individual prognostic factors and IV Ig dosages. In the absence of randomised controlled trials, this review does not provide a definite conclusion on the usefulness of IV Ig in SJS or TEN; however, the analysis of published data does not suggest a dramatic efficacy. We conclude that, in the absence of further studies, IV Ig cannot yet be considered the standard of care for SJS or TEN.