剛剛學到了Etanercept (Enbrel恩博)有趣的off-lable用法
在SJS或TEN嚴重表皮脫落症狀時，可以給予Etanercept 25 mg (for weight ≤65 kg) or 50 mg (for weight >65 kg) BIW + glucocorticoids until skin lesions heal or glucocorticoids are able to be tapered
丟perplexity得知了幾篇有趣的trial，大家有興趣可以去看看
https://www.perplexity.ai/search/what-is-the-role-of-etanercept-tgTdZ9o9S4aFjMU37K007w
但畢竟是off-label use，且這藥健保需事前審核，用在這裡只能自費一針25mg 3500元左右~要是衰一點>65kg，就要打兩針 double價錢喔~
--------------------------------------------------------
Etanercept, a tumor necrosis factor-alpha (TNF-α) antagonist, has emerged as a potential treatment option for Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), both severe cutaneous adverse reactions often triggered by medications. Here's an overview of its role in treating these conditions.
## Mechanism of Action
Etanercept works by inhibiting TNF-α, a cytokine involved in inflammatory responses. Elevated levels of TNF-α have been associated with SJS/TEN, contributing to keratinocyte apoptosis and skin damage. By blocking this cytokine, etanercept may reduce inflammation and promote skin healing[1][3].
## Clinical Evidence
**Efficacy**:
- Studies suggest that etanercept can significantly improve outcomes for patients with SJS/TEN. A retrospective study involving 22 patients indicated that a single dose of etanercept (50 mg subcutaneously) resulted in no mortality among treated individuals, contrasting sharply with an expected mortality rate of approximately 46.9%[1].
- Another study found that adding etanercept to conventional therapies like intravenous immunoglobulin (IVIG) and corticosteroids reduced hospitalization duration and the total amount of systemic steroids needed[2]. Specifically, the average length of stay was reduced from 19 days to 13.5 days when etanercept was included in the treatment regimen[2].
**Healing Time**:
- Patients receiving etanercept showed faster re-epithelialization of skin lesions, with healing times ranging from 3 to 19 days compared to longer durations in those receiving standard care alone[1][3].
## Safety Profile
Etanercept appears to have a favorable safety profile in the context of SJS/TEN. No significant adverse effects were reported in studies following treatment, and it did not lead to increased rates of serious complications compared to traditional therapies like corticosteroids[2][4].
## Conclusion
While more extensive randomized controlled trials are needed to solidify its role, current evidence supports etanercept as a **potentially life-saving** and **effective therapy** for SJS/TEN. Its ability to enhance recovery speed and reduce mortality risk makes it a valuable addition to the treatment arsenal for these critical conditions[1][4][5].
Citations:
[1] https://cdn.mdedge.com/files/s3fs-public/CT107006022_e.PDF
[2] https://pubmed.ncbi.nlm.nih.gov/35598882/
[3] https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2024.1342898/full
[4] https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013130.pub2/full
[5] https://www.sciencedirect.com/science/article/abs/pii/S2213219822001180
[6] https://www.sciencedirect.com/science/article/abs/pii/S1081120622004410
[7] https://www.annallergy.org/article/S1081-1206(22)00441-0/fulltext
[8] https://www.annallergy.org/article/S1081-1206(22)00579-8/fulltext
沒有留言:
張貼留言