Clinical characteristics of Stevens-Johnson syndrome/toxic epidermal necrolysis-like reactions induced by immune checkpoint inhibitors

Abstract

Background: Immune checkpoint inhibitors (ICIs) have demonstrated significant therapeutic benefits but are also associated with skin-related adverse reactions. The specific characteristics of severe adverse reactions caused by ICIs remain unclear.

Objective: To investigate the disease characteristics of Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN)-like reactions induced by ICIs.

Methods: Cases of ICI-induced SJS/TEN were collected from PubMed, CNKI, Wanfang Data Knowledge Service Platform, and Guangdong Provincial People's Hospital, with a search time span ranging from March 2011 to January 31, 2024.

Results: A total of 110 cases of SJS, TEN, and overlapping SJS/TEN were analyzed, with a male predominance (62%). Mucous membrane involvement was observed in 71 patients (66%), though less frequently than in classic SJS/TEN. The mean latency period was 64 days, varying by subtype (105 days for SJS and 53 days for TEN). Combination therapy with ICIs was associated with a higher mortality risk (P = .029). Deceased patients exhibited shorter latency periods (mean 30.3 days) and more severe mucosal involvement (up to 100%), although the differences were not statistically significant. Systemic glucocorticoid therapy was the cornerstone of treatment for SJS/TEN-like reactions. The addition of immunoglobulin showed a trend toward improved outcomes but did not significantly affect mortality or cure rates compared to glucocorticoid monotherapy. The combination of systemic glucocorticoids and antibiotics demonstrated a promising trend, with a higher proportion of patients in the improvement/cure group using this regimen (P = .085).

Conclusions: This study summarizes the clinical characteristics of ICI-induced SJS/TEN-like reactions, providing insights into their features and potential treatment strategies for severe skin-related adverse events induced by ICIs.

Keywords: Stevens-Johnson syndrome; immune checkpoint inhibitors; immune-related adverse events; severe cutaneous adverse reactions; toxic epidermal necrolysis.