Antiepileptic Drugs Implicated in 1 in 4 SJS/TEN Cases

TOPLINEAntiepileptic drugs (AEDs) are implicated in nearly one quarter of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) cases globally, with aromatic agents such as carbamazepine, phenytoin, and lamotrigine accounting for almost all AED-associated cases.METHODOLOGYResearchers conducted a meta-analysis of 50 observational studies published up to March 2026 and included 4403 adults and children with clinically or biopsy-confirmed SJS/TEN and patient-level drug trigger data.The primary outcome was the pooled proportion of SJS/TEN cases attributed to AED exposure.Secondary outcomes were the relative proportions of individual AEDs implicated in AED-associated SJS/TEN cases and the proportion of AEDs implicated in drug-associated SJS/TEN after excluding cases attributed to infections and unknown causes.TAKEAWAYAEDs accounted for 22.9% of all 4403 SJS/TEN cases, and 87.8% of all AED-associated cases were attributed to single drug exposure.AEDs accounted for 27.3% of 3748 drug-induced SJS/TEN cases.Aromatic AEDs caused 96.1% of the AED-associated SJS/TEN cases (46 studies; 988 patients), with carbamazepine (39%), phenytoin (19%), and lamotrigine (15%) most frequently implicated. Nonaromatic AEDs accounted for only 1.9% of the cases.Children had a higher proportion of AED-associated cases than adults (34.5% vs 23.4%; P = .03). Significant geographic variation was observed, with the highest proportion in West Asia at 41.9% and the lowest in Africa at 10.4% (P < .001).IN PRACTICE“These findings suggest aromatic AEDs as leading causes of SJS/TEN and support the preferential use of nonaromatic AEDs, especially in high-risk populations and when clinically appropriate,” the authors of the study concluded.SOURCEThe study was led by Erika Yue Lee, MD, University Health Network and Sinai Health, both in Toronto, Ontario, Canada. It was published online on July 22 in JAMA Dermatology.LIMITATIONSAll included studies were retrospective observational case series and did not specify how drug causality was determined. Many studies presented aggregated data combining SJS, overlapping SJS/TEN and TEN subtypes, preventing subgroup analysis. Substantial heterogeneity was present across studies.DISCLOSURESNo study funding information was provided. One author disclosed receiving personal fees from UpToDate, Janssen, Esperion, Verve, Eli Lilly, Mirdador, Rapt, Intellia, Elion, AstraZeneca, and Glenmark outside this work. No other disclosures were reported by the authors.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.