TY - JOUR
T1 - Management and treatment outcome of DRESS patients in Europe
T2 - An international multicentre retrospective study of 141 cases
AU - Kridin, Khalaf
AU - Brüggen, Marie Charlotte
AU - Walsh, Sarah
AU - Bensaid, Benoit
AU - Ranki, Annamari
AU - Oppel, Eva
AU - Meyersburg, Damian
AU - Chua, Ser Ling
AU - Seeli, Corsin
AU - Sandberg, Heidi
AU - French, Lars E.
AU - Vorobyev, Artem
AU - Ingen-Housz-Oro, Saskia
N1 - Publisher Copyright:
© 2022 European Academy of Dermatology and Venereology.
PY - 2023/4
Y1 - 2023/4
N2 - Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but potentially fatal drug hypersensitivity reaction. Objective: To explore treatment approaches across Europe and their impact on the disease course, as well as prognostic factors and culprit drugs. Methods: In this retrospective European multicentric study, we included patients with probable or certain DRESS (RegiSCAR score ≥ 4) between January 2016 and December 2020. Independent associations between clinical parameters and the risk of intensive care unit admission and mortality at three months were assessed using a multivariable-adjusted logistic regression model. Results: A total of 141 patients from 8 tertiary centres were included. Morbilliform exanthem was the most frequent cutaneous manifestation (78.0%). The mean affected body surface area (BSA) was 67%, 42% of the patients presented with erythroderma, and 24.8% had mucosal involvement. Based on systemic involvement, 31.9% of the patients had a severe DRESS. Anticonvulsants (24.1%) and sulphonamides (22.0%) were the most frequent causative agents. In all, 73% of the patients were treated with systemic glucocorticoids, and 25.5% received topical corticosteroids as monotherapy. Few patients received antiviral drugs or anti-IL5. No patients received intravenous immunoglobulins. The overall mortality was 7.1%. Independent predictors of mortality were older age (≥57.0 years; fully adjusted OR, 9.80; 95% CI, 1.20–79.93; p = 0.033), kidney involvement (fully adjusted OR, 4.70; 95% CI, 1.00–24.12; p = 0.049), and admission in intensive care unit (fully adjusted OR, 8.12; 95% CI, 1.90–34.67; p = 0.005). Relapse of DRESS and delayed autoimmune sequelae occurred in 8.5% and 12.1% of patients, respectively. Conclusions: This study underlines the need for diagnostic and prognostic scores/markers as well as for prospective clinical trials of drugs with the potential to reduce mortality and complications of DRESS.
AB - Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but potentially fatal drug hypersensitivity reaction. Objective: To explore treatment approaches across Europe and their impact on the disease course, as well as prognostic factors and culprit drugs. Methods: In this retrospective European multicentric study, we included patients with probable or certain DRESS (RegiSCAR score ≥ 4) between January 2016 and December 2020. Independent associations between clinical parameters and the risk of intensive care unit admission and mortality at three months were assessed using a multivariable-adjusted logistic regression model. Results: A total of 141 patients from 8 tertiary centres were included. Morbilliform exanthem was the most frequent cutaneous manifestation (78.0%). The mean affected body surface area (BSA) was 67%, 42% of the patients presented with erythroderma, and 24.8% had mucosal involvement. Based on systemic involvement, 31.9% of the patients had a severe DRESS. Anticonvulsants (24.1%) and sulphonamides (22.0%) were the most frequent causative agents. In all, 73% of the patients were treated with systemic glucocorticoids, and 25.5% received topical corticosteroids as monotherapy. Few patients received antiviral drugs or anti-IL5. No patients received intravenous immunoglobulins. The overall mortality was 7.1%. Independent predictors of mortality were older age (≥57.0 years; fully adjusted OR, 9.80; 95% CI, 1.20–79.93; p = 0.033), kidney involvement (fully adjusted OR, 4.70; 95% CI, 1.00–24.12; p = 0.049), and admission in intensive care unit (fully adjusted OR, 8.12; 95% CI, 1.90–34.67; p = 0.005). Relapse of DRESS and delayed autoimmune sequelae occurred in 8.5% and 12.1% of patients, respectively. Conclusions: This study underlines the need for diagnostic and prognostic scores/markers as well as for prospective clinical trials of drugs with the potential to reduce mortality and complications of DRESS.
UR - http://www.scopus.com/inward/record.url?scp=85144329740&partnerID=8YFLogxK
U2 - 10.1111/jdv.18808
DO - 10.1111/jdv.18808
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C2 - 36479739
AN - SCOPUS:85144329740
SN - 0926-9959
VL - 37
SP - 753
EP - 762
JO - Journal of the European Academy of Dermatology and Venereology
JF - Journal of the European Academy of Dermatology and Venereology
IS - 4
ER -
