Summary of findings 6. Etanercept compared to corticosteroids.

Summary of findings:
Etanercept compared to corticosteroids for treatment of Stevens‐Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap syndrome
Patient or population: treatment of Stevens‐Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap syndrome Setting: inpatient hospital, serving as a regional referral centre for SJS/TEN cases Intervention: etanercept and supportive care Comparison: corticosteroids and supportive care (specifics of supportive care not identified by study)
Outcomes	Anticipated absolute effects* (95% CI)		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
	Risk with corticosteroids	Risk with etanercept
Disease‐specific mortality (time to follow‐up not reported)	163 per 1000	83 per 1000 (26 to 265)	RR 0.51 (0.16 to 1.63)	91 (1 RCT)	⨁⨁◯◯ LOW a	‐
Time to complete re‐epithelialisation ‐ not reported	‐	‐	‐	‐	‐	‐
Intensive care unit (ICU) length of stay ‐ not reported	‐	‐	‐	‐	‐	‐
Total hospital length of stay ‐ not reported	‐	‐	‐	‐	‐	‐
Adverse effects leading to discontinuation of SJS/TEN therapy ‐ not reported (see comments)	‐	‐	‐	‐	‐	1 study reported that 5/48 participants in the etanercept group had serious adverse events (sepsis, respiratory failure, and bipolar disorder) and 9/43 in the corticosteroids group (sepsis, respiratory failure, upper gastrointestinal haemorrhage, stridor and vocal cord palsy) (Wang 2018). It is unclear from the trial report if any of these adverse events led to discontinuation of treatment or if they were attributed to systemic therapy.
*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; RCT: randomised controlled trial; 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 imprecision, as the confidence interval is wide and includes benefits and harms, and results were from one small study.