Evidence of a Therapeutic Window for TNF-α Inhibitor and Intravenous Immunoglobulin Benefits in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Treatment: A Multicenter 6-Year Retrospective Study.

Abstract

TNF-α inhibitor and intravenous immunoglobulin (IVIG) are effective adjunctive therapies to glucocorticoids in Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), but the optimal timing for this combination therapy remains unclear. To compare the efficacy of different treatments in patients with SJS/TEN to identify the optimal timing. This multicenter retrospective study included patients with SJS/TEN treated with corticosteroids, with or without TNF-α inhibitors and/or IVIG, at three medical centers from July 2018 to January 2025. Patients were stratified into four treatment groups and compared for outcomes including cessation of new lesions, initiation of reepithelialization, and length of hospital stay. Among 139 patients with SJS/TEN, 40 received corticosteroid monotherapy, 30 received TNF-α inhibitors plus corticosteroids, 39 received IVIG plus corticosteroids, and 30 received triple combination with TNF-α inhibitors, IVIG, and corticosteroids. Compared with corticosteroid monotherapy, early initiation of TNF-α inhibitors within 13 days or IVIG within 7 days of rash onset was associated with significantly faster cessation of new lesion development and earlier reepithelialization, although no significant differences were observed in hospitalization. The triple combination with TNF-α inhibitors, IVIG, and corticosteroids was also associated with a significantly shorter time to cessation of new lesions and reduced reepithelialization time compared with corticosteroid monotherapy, but not with hospitalization. Notably, the triple combination group had the lowest cumulative and weight-adjusted corticosteroid doses. For treating SJS/TEN, adding TNF-α inhibitors within 13 days of the onset of rash or IVIG within 7 days was associated with a significantly shorter time to new lesion cessation and reepithelialization, but later use provided no additional benefit.