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Finding causative drugs for deadly adverse reactions from a claims database

Published online: October 12, 2019

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening adverse drug reactions. Some drugs, such as allopurinol and aromatic anticonvulsants, are known to cause SJS/TEN at a higher rate than others do. However, due to the rarity and the lack of appropriate diagnostic methods, it has been challenging to identify the culprit drugs of SJS/TEN in clinical settings.

In an article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Yang et al. reported a novel approach to resolve this issue using a national claims database. The authors identified subjects with diagnostic codes for SJS and TEN. Afterwards, they reviewed and scored all of the drugs prescribed to the subjects according to an ALgorithm of Drug causality for Epidermal Necrolysis (ALDEN), a well-accepted drug causality assessment algorithm for SJS and TEN elaborated by the RegiSCAR study group. The authors identified 33 very probable, 101 probable, and 57 possible culprit drugs among all the drugs prescribed to 187 subjects. In addition to the drugs that are well known to cause SJS and TEN such as allopurinol (19 cases), carbamazepine (17 cases), and lamotrigine (13 cases), carbonic anhydrase inhibitors (17 cases) were also found as possible culprits to frequently cause SJS and TEN among a Korean population.

The findings suggest that a large database of each country could be used to build a national database of causative drugs of severe adverse drug reactions, and this approach could shed light on policymaking for drug adverse reactions.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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