Summary of findings 1. Corticosteroids compared to no corticosteroids.
| Summary of findings: | ||||||
| Corticosteroids compared to no corticosteroids for treatment of Stevens‐Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap syndrome | ||||||
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Patient or population: Stevens‐Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap syndrome Setting: inpatient hospital wards Intervention: corticosteroids and supportive care Comparison: supportive care1 | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with supportive care | Risk with corticosteroids | |||||
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Disease‐specific mortality ‐ SJS and TEN (time to follow‐up not reported) |
91 per 1000 | 232 per 1000 (65 to 821) |
RR 2.55 (0.72 to 9.03) |
56 (2 observational studies) | ⨁◯◯◯ VERY LOW a,b | Effect estimates calculated from 1 study (Azfar 2010). A second study did not report any events (Kakourou 1997). |
| Time to complete re‐epithelialisation – not reported | Not reported | ‐ | ‐ | ‐ | ‐ | |
| Intensive care unit (ICU) length of stay ‐ not reported | Not reported | ‐ | ‐ | ‐ | ‐ | |
| Total hospital length of stay – not reported | Not reported | ‐ | ‐ | ‐ | ‐ | |
| Adverse effects leading to discontinuation of SJS/TEN therapy – not reported | Not reported | ‐ | ‐ | ‐ | ‐ | |
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1 Supportive care process in 1 study was not described (Azfar 2010). In the second study this was described in detail and includes topical saline compresses and sprays, petroleum jelly, bathing, topical lidocaine gel to the oral mucosa and topical antibiotics and artificial tears to the eyes (Kakourou 1997). *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
aDowngraded two levels due to risk of selection bias and lack of control of any confounding variables. bDowngraded two levels for imprecision, as results only based on small studies, and the confidence interval includes serious harms and an important benefit.