Revisión de la evidencia del uso de ciclosporina en la necrólisis epidérmica

Abstract

The evidence supporting the use of cyclosporine in epidermal necrolysis (EN) is reviewed. Given the lack of controlled and randomized studies due to the low incidence of the disease, retrospective cohort studies are evaluated, highlighting a study that compares two centers in Madrid obtaining better survival results in the one in which cyclosporine was used compared to the other that used mostly immunoglobulins. These results coincide with a meta-analysis of 9 studies and 256 patients with EN treated with cyclosporine that found a significant reduction in the risk of mortality compared with the SCORTEN prediction. However, in a subsequent single-center retrospective study representing the longest series of cyclosporine use in EN (95 patients), the addition of cyclosporine did not improve mucocutaneous re-epithelialization, did not reduce disease progression or mortality, but it did increase renal failure significantly (p <0.05). A phase III, multicenter, randomized, double-blind study will be initiated shortly to compare the efficacy of etanercept, cyclosporine, and supportive therapy in EN. Hopefully this study can be fully developed, and sheds light on the role of these therapies in EN.