Ароматические противосудорожные препараты вызывают 96% случаев синдрома Стивенса-Джонсона

Nearly 1 in 4 reported patients with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are associated with antiepileptic drug exposure, according to findings published in JAMA Dermatology. Although aromatic antiepileptic drugs are established risk factors for severe cutaneous adverse reactions, their overall contribution to SJS/TEN across diverse patient populations has not been well quantified. Researchers conducted a systematic review and meta-analysis to estimate the proportion of SJS/TEN patients associated with antiepileptic drug exposure and to characterize the medications most commonly involved. The analysis included experimental and observational studies reporting patient-level implicated drugs identified through MEDLINE and Embase searches completed in March 2026. The researchers calculated pooled estimates using random-effects models and explored whether findings differed by age group or geographic region. The primary analysis estimated the proportion of SJS/TEN diagnoses associated with antiepileptic drug exposure, with additional analyses examining individual antiepileptic drugs most frequently implicated in these reactions. These findings suggest aromatic [antiepileptic drugs] as leading causes of SJS/TEN and support the preferential use of nonaromatic [antiepileptic drugs], especially in high-risk populations and when clinically appropriate. Overall, 50 retrospective observational studies encompassing 4403 patients with individually identified SJS/TEN drug triggers met the inclusion criteria for the meta-analysis. Of the included studies, 24 were conducted in Asia, 17 in North America, 4 in Europe, 4 in Africa, and 1 in Australia. Overall, single-drug exposures accounted for 87.8% (95% CI, 83.1%-91.9%) of SJS/TEN events. Antiepileptic drugs were implicated in 22.9% (95% CI, 19.4%-26.4%) of all SJS/TEN events and 27.3% (95% CI, 23.6%-31.1%) of drug-induced events after excluding infections and events with unknown causes. Assessment of publication bias did not identify evidence of significant bias. Among antiepileptic drug-associated events, aromatic antiepileptic drugs accounted for 96.1% (95% CI, 92.1%-99.0%) of implicated medications. Carbamazepine was the most frequently associated drug, representing 39.1% (95% CI, 28.9%-49.7%) of antiepileptic drug-associated SJS/TEN cases, followed by phenytoin (19.0%; 95% CI, 10.9%-28.4%) and lamotrigine (14.6%; 95% CI, 8.4%-21.8%). By comparison, nonaromatic antiepileptic drugs accounted for 1.9% (95% CI, 0.4%-4.0%) of antiepileptic drug-associated events. Subgroup analyses demonstrated significant differences according to age and geographic region. The pooled proportion of antiepileptic drug-associated SJS/TEN was significantly higher among children than adults (34.5% vs 23.4%; P =.03). By geographic region, the highest proportion was observed in West Asia (41.9%), followed by South Asia (34.9%), whereas Africa had the lowest proportion (10.4%; P <.001). Meta-regression also showed that more recently published studies reported higher proportions of antiepileptic drug-associated SJS/TEN, although publication year explained only a small amount of between-study variability. Publication year explained 5.6% of the between-study variability. Study limitations include the observational design of all included studies, exclusion of studies lacking patient-level drug trigger data, limited reporting on drug causality methods, inability to evaluate SJS and TEN separately, substantial residual heterogeneity, and a lack of regional antiepileptic drug prescribing data. “These findings suggest aromatic [antiepileptic drugs] as leading causes of SJS/TEN and support the preferential use of nonaromatic [antiepileptic drugs], especially in high-risk populations and when clinically appropriate,” the study authors concluded. Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures. References: Lee EY, Knox C, Sugumar C, Phillips EJ. Proportion of antiepileptic drug-associated Stevens-Johnson Syndrome and toxic epidermal necrolysis: a meta-analysis. JAMA Dermatol. Published online July 22, 2026. doi:10.1001/jamadermatol.2026.2473