87 Etanercept Is Safe and Efficacious for Treating Stevens-Johnson Syndrome and Toxic Epidermal Necroylsis

Abstract Introduction Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) is a dermatologic autoimmune condition with significant morbidity and mortality. The optimal treatment for this rare disease has not yet been elucidated, and treatment protocols can vary by institution. Our treatment protocol and outcomes over a 15-year period were previously reported, and noted a 10% mortality rate, the lowest reported in the literature to date. Here, we review our use of the anti-tumor necrosis factor (TNF) agent, Etanercept, in the belief that it is safe and may improve outcomes in SJS/TEN patients. Methods A retrospective chart review was performed at a single institution. Etanercept was first used in our institution in May 2015 and the charts of all consecutive patients admitted to the burn unit with a histological diagnosis of SJS/TEN were reviewed. We documented the received treatments and outcomes for each patient, including demographics, complications, and mortality. The outcomes of the Etanercept-treated patients were compared with our previously published cohort, which was performed at the same institution, with minimal turnover in burn unit staff, and an established treatment protocol involving IVIG and aggressive wound care. Results Since May 2015, 13 total consecutive SJS/TEN patients (2–90% TBSA) were treated with Etanercept. In comparison to SJS/TEN patients who did not receive Etanercept, the treated cohort had significantly fewer ICU days (6.9 vs 15.1, p=0.034) and trends toward shorter total length-of-stay (9.8 vs 16.4, p=0.156) as well as fewer infectious complications (38.5% vs 57.5%, p=0.476). There was no significant difference in mortality rate (15.4% vs 10%, p=0.620). In general, the patients treated with Etanercept had significantly more severe presentations with higher SCORTEN scores (3 vs 2, p=.029) and longer delays in presentation (5.7 days vs 2.6 days, p=.001) with a trend toward greater skin involvement (54.3% vs 46.3%, p=.400). Conclusions Our experience suggests that the treatment of SJS/TEN patients with Etanercept in addition to IVIG and wound care in a burn unit is safe and may improve outcomes. We now consider it as part of our standard treatment protocol. Each patient should be evaluated on a case-by-case basis for contraindications to Etanercept. To our best knowledge, this is the largest reported study of the treatment of SJS/TEN with Etanercept. Given our promising results, larger studies are indicated to further el