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Meta-Analysis
. 2016 Nov 30;11(11):e0167120.
doi: 10.1371/journal.pone.0167120. eCollection 2016.

The Effect of Intravenous Immunoglobulin Combined with Corticosteroid on the Progression of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Meta-Analysis

Liang-Ping Ye  1   2 , Cheng Zhang  3 , Qi-Xing Zhu  1   3
Affiliations
Meta-Analysis

The Effect of Intravenous Immunoglobulin Combined with Corticosteroid on the Progression of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Meta-Analysis

Liang-Ping Ye et al. PLoS One. .

Abstract

Background: Intravenous immunoglobulin (IVIG) treatment is commonly used to treat Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) with controversial therapeutic effect.

Methods: We conducted a comprehensive meta-analysis through combining the published eligible studies to evaluate the effectiveness of IVIG on SJS and TEN treatment.

Results: A total of 26 studies were selected from public available databases. The combination of IVIG and corticosteroid markedly reduced the recovery time (by 1.63 days, 95% CI: 0.83-2.43, P < 0.001), compared with solo corticosteroid group. The favorable effects were greater in Asian (2.19, 95% CI: 1.41-2.97, P < 0.001), TEN (2.56, 95% CI: 0.35-4.77, P = 0.023) and high-dose IVIG treated individuals (1.78, 95% CI: 0.42-3.14, P = 0.010). The hospitalization length reduced by 3.19 days (95% CI: 0.08-6.30, P = 0.045), though the outcome was proven to be unstable. We found heterogeneities, which sources were probably regional factors. Besides, IVIG was inclined to decrease SJS/TEN mortality (SMR: 0.84, 95% CI: 0.66-1.08, P = 0.178). This impact was possibly more profound when patients were treated with high dose IVIG (SMR: 0.74, 95% CI: 0.50-1.08, P = 0.116), or when patients were diagnosed as TEN (SMR: 0.68, 95% CI: 0.45-1.01, P = 0.058).

Conclusions: Our current meta-analysis suggests that IVIG combined with corticosteroid could reduce recovery time for SJS and TEN. This effect is greater among Asian patients. Whereas, its impact on reducing mortality is not significant.

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Conflict of interest statement

This article does not have any actual or potential conflict of interest including financial, personal or other relationships with other people or organizations.

Figures

Fig 1
Fig 1. Flow diagram of eligible studies selection.
Fig 2
Fig 2. Analysis and assessment of the effect of combination therapy on SJS/TEN recovery.
A: forest plot of the impact of combined therapy stratified by IVIG dose; B: forest plot of the impact of combined therapy stratified by diagnosis; C: forest plot of the impact of combined therapy stratified by age; D: forest plot of the impact of combined therapy stratified by area; E: sensitivity analysis to check the reliability of the pooled result.
Fig 3
Fig 3. Analysis and assessment of the effect of combination therapy on SJS/TEN admission length.
A: forest plot of the impact of combined therapy stratified by IVIG dose; B: forest plot of the impact of combined therapy stratified by diagnosis; C: forest plot of the impact of combined therapy stratified by age; D: forest plot of the impact of combined therapy stratified by area; E: sensitivity analysis to check the reliability of the pooled result.
Fig 4
Fig 4. Analysis and assessment of the effect of IVIG therapy on SJS/TEN SMR.
A: forest plot of the impact of IVIG therapy stratified by different areas; B: forest plot of the impact of IVIG therapy stratified by different therapeutic patterns; C: forest plot of the impact of IVIG therapy stratified by IVIG dose; D: forest plot of the impact of combined therapy stratified by diagnosis; E: sensitivity analysis to check the reliability of the pooled results.
Fig 5
Fig 5. Detection of publication bias by evaluating the symmetry of funnel plot.
A: funnel plot test on studies regarding the impact of combined therapy on SJS/TEN recovery; B: funnel plot test on studies regarding the impact of combined therapy on the time to stay in hospital; C: funnel plot test on studies regarding the impact of IVIG therapy on SJS/TEN mortality.
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