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Bonnie W Leung

 

Bonnie W Leung

Baylor College of Medicine, USA

Abstract Title: Longitudinal trends in the management and outcomes of Stevens–johnson syndrome and toxic epidermal necrolysis: A decade-long population-level cohort study

Biography:

Research Interest:

Background: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, life-threatening mucocutaneous reactions, most often triggered by medications.1 Despite the severity of SJS/TEN and decades of investigation, evidence-based consensus on systemic therapy remains elusive. This study presents the largest and most contemporary assessment of real-world management practices, with the goal of informing future therapeutic trials and evidence-based treatment protocols.

Methods: Using Epic Cosmos, a multi-institutional electronic health records database that includes 1,762 hospitals and 300 million patients, we conducted a population-based cohort study of 12,388 patients diagnosed with SJS/TEN between June 25, 2015 and June 25, 2025.2 Use of systemic corticosteroids, cyclosporine, etanercept, infliximab, and intravenous immunoglobulin (IVIG) within 10 days of diagnosis, as well as skin biopsy rates, hospitalization metrics, and mortality, was evaluated.

Results: Systemic corticosteroid use increased from 22.6% in 2015 to 43.4% in 2025, while cyclosporine use rose from 4.3% to 10.9%. Etanercept use remained limited, reaching 5.5% in 2025. Both IVIG and infliximab persisted below 1% throughout the study period. (Figure 1) Skin biopsy rates grew from 1.7% in 2016 to 15.0% in 2025. The most frequent therapeutic combinations were corticosteroids with cyclosporine (6.8%) and corticosteroids with etanercept (1.8%). (Table 1) Average hospital length of stay remained stable, with SJS patients hospitalized for 7 to 8 days, and TEN patients hospitalized for 10 to13 days. Hospital mortality remained approximately 8.

Conclusions: Over the past ten years, management of SJS/TEN has shifted toward greater use of systemic corticosteroids and modest uptake of cyclosporine and etanercept. Despite these changes, hospital mortality and length of stay remained stable. Limited adoption of non-steroidal immunomodulators likely reflects persistent uncertainty regarding their efficacy, concerns about infection risk, and lack of consensus management guidelines.