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MEDICATION USE AND THE RISK OF STEVENS-JOHNSON SYNDROME OR TOXIC EPIDERMAL NECROLYSIS

MEDICATION USE AND THE RISK OF STEVENS-JOHNSON SYNDROME OR T...

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中成药上市后药物流行病学评价培训会议

作者： JEAN-CLAUDE ROUJEAU JUDITH P.KELLY LUIGI NALDI BERTHOLD RZANY ROBERT S.STERN THERESA ANDERSON ARIANE AUQUIER SYLVIE BASTUJI-GARIN OSVALDO CORREIA FRANCESCO LOCATI MAJA MOCKENHAUPT catherine paoletti SAMUEL SHAPIRO NEIL SHEAR ERWIN SCHPF DAVID W.KAUFMAN Department of Dermatology Universite Paris Ⅻ CreteilFrance M.D. the Slone Epidemiology Unit Boston University School of MedicineBostonM.S. Gruppo Italiano Studi Epidemiologici in Dermatologia Department of DermatologyUniversita degli Studi di MilanoBergamoItalyM.D. the Department of Dermatology Beth Israel HospitalHarvard Medical SchoolBostonM.D. the Slone Epidemiology Unit Boston University School of MedicineBostonR.N. the Department of Biostatistics and Epidemiology INSERM Unite 351Institut Gustave-RoussyVillejuifFranceM.S. the Department of Public Health Universite Paris Ⅻ CreteilFranceM.D. Grupo Portugues EIYS Department of Dermatology and ImmunologyHospital S.JoaoFaculdade de MedicinaPortoPortugalM.D. the Department of Biostatistics and Epidemiology INSERM Unite 351Institut Gustave-RoussyVillejuifFrance the Slone Epidemiology Unit Boston University School of MedicineBostonM.B.F.R.C.P.(E.) the Department of Pharmacology Sunnybrook Health Science CentreTorontoM.D. the Slone Epidemiology Unit Boston University School of MedicineBostonSC.D.

*** epidermal necrolysis and Stevens-Johnson syndrome are rare,life-threatening, drug-induced cutaneous *** conducted a case-control study to quantify the risks associated with the use of specific drugs. *** were obtained through surveillance networks in France,Germany,Italy,and *** use before the onset of disease was compared in 245 people who were hospitalized because of toxic epidermal necrolysis or Stevens-Johnson syndrome and 1147 patients hospitalized for other reasons(controls).Crude relative risks were calculated and adjusted for confounding by multivariate methods when numbers were large enough. *** drugs usually used for short periods, the risks were increased for trimethoprim-sulfamethoxazole and other sulfonamide antibiotics(crude relative risk,172;95 percent confidence interval,75 to 396), chlormezanone(crude relative risk,62;21 to 188),aminopenicillins (multivariate relative risk,6.7;2.5 to 18), quinolones(multivariate relative risk,10;2.6 to 38),and cephalosporins(multivariate relative risk,14;3.2 to 59). For acetaminophen,the multivariate relative risk was 0.6 (95 percent confidence interval,0.2 to 1.3) in France but 9.3(3.9 to 22) in the other *** drugs usually used for months or years,the increased risk was confined largely to the first two months of treatment, when crude relative risks were as follows:carbamazepine, 90(95 percent confidence interval,19 to∞);phenobarbital, 45(19 to 108);phenytoin,53(11 to∞);valproic acid,25(4.3 to∞);oxicam nonsteroidal antiinflammatory drugs(NSAIDs),72(25 to 209);allopurinol,52(16 to 167);and corticosteroids,54(23 to 124).For many drugs,including thiazide diuretics and oral hypoglycemic agents,there was no significant increase in risk. *** use of antibacterial sulfonamides, anticonvulsant agents,oxicam NSAIDs,allopurinol,chlormezanone, and corticosteroids is associated with large increases in the risk of Stevens-Johnson syndrome or toxic epi

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