Management and treatment outcome of DRESS patients in Europe: An international multicentre retrospective study of 141 cases. (19th December 2022)

• Record Type: Journal Article
• Authors: Kridin, Khalaf; Brüggen, Marie‐Charlotte; Walsh, Sarah; Bensaid, Benoit; Ranki, Annamari; Oppel, Eva; Meyersburg, Damian; Chua, Ser‐Ling; Seeli, Corsin; Sandberg, Heidi; French, Lars E.; Vorobyev, Artem; Ingen‐Housz‐Oro, Saskia
• Is Part Of: Journal of the European Academy of Dermatology and Venereology. Volume 37:Number 4(2023)supplement 3
• Page Start: 753
• Page End: 762
• Publication Date: 2022-12-19
• Subjects: Dermatology -- Periodicals; Sexually transmitted diseases -- Periodicals; 616.5
• DOI: 10.1111/jdv.18808
• Languages: English
• ISSNs: 0926-9959

Abstract

Abstract: 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.