Searching for the Culprit Drugs for Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis from a Nationwide Claim Database in Korea

Min-Suk Yang; Jin Yong Lee; Jayeun Kim; Gun-Woo Kim; Byung-Keun Kim; Ju Young Kim; Heung-Woo Park; Sang-Heon Cho; Kyung-Up Min; Hye-Ryun Kang

doi:10.1016/j.jaip.2019.09.032

Searching for the Culprit Drugs for Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis from a Nationwide Claim Database in Korea

J Allergy Clin Immunol Pract. 2020 Feb;8(2):690-695.e2. doi: 10.1016/j.jaip.2019.09.032. Epub 2019 Oct 12.

Authors

Min-Suk Yang¹, Jin Yong Lee², Jayeun Kim³, Gun-Woo Kim⁴, Byung-Keun Kim⁵, Ju Young Kim⁶, Heung-Woo Park⁷, Sang-Heon Cho⁸, Kyung-Up Min⁷, Hye-Ryun Kang⁹

Affiliations

¹ Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea; Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
² Department of Public Health and Community Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea; Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea.
³ Institute of Health and Environment, Seoul National University, Seoul, Korea.
⁴ Department of Internal Medicine, Saint Carollo General Hospital, Suncheon si, Jeollanam-do, Korea.
⁵ Department of Internal Medicine, Korea University Medical Center Anam Hospital, Seoul, Korea.
⁶ Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon-si, Gyeongsangnam-do, Korea.
⁷ Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
⁸ Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea.
⁹ Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea. Electronic address: helenmed@snu.ac.kr.

PMID: 31614216
DOI: 10.1016/j.jaip.2019.09.032

Abstract

Background: Ethnic differences exist in relation to culprit drugs for Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). We wanted to determine culprit drugs for SJS and TEN in Korean population.

Objective: To evaluate culprit drugs for SJS and TEN by applying an algorithm for assessment of drug causality for epidermal necrolysis (ALDEN) in a nationwide administrative database.

Methods: We used the claims database, which included claims data for the entire South Korean population. A retrospective cohort study was conducted by collecting subjects who were first diagnosed with SJS and TEN in 2011. All drugs prescribed to the subjects were reviewed and scored according to the ALDEN score. Drugs with an ALDEN score ≥2 were considered culprit drugs.

Results: A total of 187 subjects were included in the culprit drug analysis; 33 very probable, 101 probable, and 57 possible culprit drugs were identified for SJS and TEN according to the ALDEN score. The most frequently suspected culprit drug was allopurinol (19 cases), followed by carbamazepine (17 cases), lamotrigine (13 cases), amoxicillin (9 cases), and dorzolamide (9 cases). Most cases (78.8%, 52 of 66) associated with the use of allopurinol, carbamazepine, lamotrigine, dorzolamide, and methazolamide occurred between 13 and 44 days after initiating the drug.

Conclusion: We applied the ALDEN score to the claims database to identify possible culprit drugs for SJS and TEN in South Korea. This approach could shed light on research and policymaking for drug adverse reactions.

Keywords: Causality; Health care administrative claims; Logic; Pharmaceutical preparations; Stevens-Johnson syndrome.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Databases, Factual
Humans
Pharmaceutical Preparations*
Republic of Korea / epidemiology
Retrospective Studies
Stevens-Johnson Syndrome* / drug therapy
Stevens-Johnson Syndrome* / epidemiology

Substances

Pharmaceutical Preparations