IVIG in Combination with Corticosteroids Reduces Morbidity and Mortality in Toxic Epidermal Necrolysis

Low-dose intravenous immune globulin (IVIG) added to a course of corticosteroids has been found to be superior to corticosteroid therapy alone in resolving toxic epidermal necrolysis (TEN) and reducing associated mortality risk, according to a clinical study by Indian investigators. Thirty-six consecutive TEN patients were alternately assigned to 1) low-dose IVIG (from 0.2 to 0.5 g/kg) and a rapidly tapering course of intravenous dexamethasone (from 0.1 to 0.3 mg/kg/day) tapered in one to two weeks or 2) the same dose range of dexamethasone only.

The two groups of 18 patients had comparable baseline characteristics, including age, sex ratio, score of toxic epidermal necrosis (SCORTEN), body surface area involvement and treatment interval. The time to arrest of disease progression and for re-epithelialization was significantly shorter in the IVIG/dexamethasone group (P = 0.0001 and P = 0.0009, respectively). While the duration of hospital stay and death rate was also lower in the IVIG/dexamethasone group, the difference was not statistically significant. However, SCORTEN-based standardized mortality ratio (SMR) analysis revealed that combination therapy reduced the probability of dying by 82% (SMR = 0.18 ± 0.36). The difference in SMR was statistically significant (P = 0.00001).

No significant side effects were associated with either treatment modality. The investigators concluded that “combination therapy with low-dose IVIG and steroids is more effective in terms of reduced mortality and faster disease resolution when compared to steroids alone in TEN.”