A COMPARATIVE EFFECTIVENESS ANALYSIS OF TOPICAL VS SYSTEMIC CORTICOSTEROIDS FOR DRESS SYNDROME

Abstract

Introduction

Emerging observational data suggest topical corticosteroids (TS) without systemic steroids (SS) may be sufficient for the treatment of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome in certain cases. We compared outcomes for hospitalized DRESS treated with TS versus SS.

Methods

DRESS cases were identified from electronic health records, confirmed by manual chart review, and categorized by steroid therapy regimen: TS group was started on topical steroids only versus SS who were started on systemic steroids +/- topical steroids. For those who transitioned from TS to SS group, time in each treatment group was counted accordingly. We calculated discharge and mortality rates for each group. We performed Cox-proportional hazard regression to estimate hazard ratio (HR) and adjusted potential confounders using overlap weighting of the propensity score.

Results

Of 281 DRESS cases, 242 (76%) were in SS group and 78 (24%) were in TS group. In the TS group, 40 then received systemic steroids. During follow-up, 7 patients (2.9/1000 person-days) died in SS group compared to 3 (4.2/1000 person-days) in TS. The adjusted HR of mortality for SS versus TS was 0.64 (95% CI: 0.08, 5.07). The discharge rate was 82.1/1000 person-days for SS and 110.6/1000 days for TS. The adjusted HR of discharge for SS versus TS was 0.77 (95% CI: 0.53, 1.13).

Conclusion

Compared with TS, SS tends to have lower mortality and shorter duration of hospitalization, albeit non-statistically significant owing to a relatively small sample size. Our findings suggest TS without SS should be used with caution in inpatient DRESS treatment.