The role of intravenous immunoglobulin in toxic epidermal necrolysis: a retrospective analysis of 64 patients managed in a specialized centre

Summary Background Toxic epidermal necrolysis ( TEN ) is a severe cutaneous adverse drug reaction with a mortality of 40%. Intravenous immunoglobulin ( IVI g) is widely used as a specific treatment for this reaction, although evidence of its benefit is conflicting. Objectives We sought to evaluate whether the use of IVI g improved mortality in patients with Stevens–Johnson syndrome ( SJS )/ TEN overlap and TEN . Methods We retrospectively analysed data for 64 patients with SJS / TEN overlap and TEN who were treated with IVI g at a single referral centre. The primary outcome analysed was in‐hospital mortality. Predicted mortality was calculated based on severity‐of‐illness score for TEN ( SCORTEN ) values. Secondary analyses of survival based on IVI g dosages and prior corticosteroid exposure were also performed. Results There were 28 cases of SJS / TEN overlap and 36 cases of TEN , with a mean SCORTEN value of 2·6. The mean dose of IVI g given was 2·4 g kg −1 and the mean delay from the onset of epidermal detachment to administration of IVI g was 3·2 days. There were 20 deaths (31%) in our cohort. The standardized mortality rate was 1·10 (95% confidence interval 0·62–1·58). Subgroup analysis comparing survivors and nonsurvivors showed a higher SCORTEN in nonsurvivors (3·4 vs. 2·2). There were no differences with regard to the dosage, delay and duration of IVI g administration. When stratified according to dosage, there was no mortality difference between patients who receive high‐dose (≥ 3 g kg −1 ) vs. low‐dose (< 3 g kg −1 ) IVI g. Conclusions This study shows that the use of IVI g does not yield survival benefits in SJS / TEN overlap and TEN , even when corrected for IVI g dosages.