Work

Cytokine profile-guided management of Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN): A management algorithm useful for guiding the selection of treatment options

Year: 2025

Type: article

Abstract: BACKGROUND: Because different immunosuppressive therapies have their own characteristic properties to inhibit/enhance the production of various cytokines in Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), cytokine profile dynamics could be used to predict and monitor the therapeutic response across different treatments, when assessed at baseline and following therapy. METHODS: This retrospective analysis was performed to assess how changes in cytokine profiles available in clinics contributed to an optimal therapeutic response in SJS/TEN patients. We included 31 patients with SJS/TEN, treated with standard corticosteroids (n = 9), pulse corticosteroids (n = 11), intravenous immunoglobulins (n = 4), plasmapheresis (n = 6), and supportive therapy (n = 1). RESULTS: High granulysin (≥ 1.6 ng/ml) and soluble Fas ligand (≥ 2540 pg/ml) levels at baseline were strong predictors for the failure of standard corticosteroid therapy. We found that standard corticosteroid treatment inhibited not only Th1 cytokines but also monocyte-derived cytokines in patients exhibiting an adequate treatment response. Although pulse corticosteroids have a fundamentally similar effect as standard corticosteroids on cytokine profiles, pulse corticosteroids more efficiently reduced monocyte-derived cytokines. Intravenous immunoglobulins suppressed interferon-γ and interleukin (IL)-12p40 production more efficiently compared with standard corticosteroids and other immunosuppressive agents. A profound decrease in granulocyte colony-stimulating factor and IL-10 associated with a marked increase in IL-12 was specifically detected in SJS/TEN patients treated with plasmapheresis. CONCLUSIONS: We can select the most appropriate treatment option for individual patients following the failure of standard corticosteroids by examining treatment-relevant cytokine profiles before and after treatment. We propose a treatment algorithm that can serve as a decision-making tool for tailored therapy selection.

Source: Allergology International

DOI: 10.1016/j.alit.2025.09.005

Authors: Yoshiko Mizukawa, Tetsuo Shiohara

Institution: Kyorin University

Language: English

Topic: Drug-Induced Adverse Reactions

Subfield: Pharmacology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,280