Proportion of Antiepileptic Drug-Associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Meta-Analysis
Abstract
Importance: Antiepileptic drugs (AEDs) are frequently implicated in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), which are the most severe type of drug hypersensitivity reaction, with a mortality rate up to 50%. However, the overall proportion of these cases attributed to AEDs has not been systematically reviewed.
Objective: To evaluate the proportion of AED-associated SJS/TEN.
Data sources: The MEDLINE and Embase databases were searched from inception through March 17, 2026, with results limited to English-language publications and human participants.
Study selection: All experimental and observational studies that reported patient-level triggers of SJS/TEN were included.
Data extraction and synthesis: Two reviewers independently screened studies and extracted data using a predefined template. To estimate the proportion of AED-associated SJS/TEN, a random-effects meta-analysis was performed, calculating the pooled proportions with 95% CIs. Subgroup analyses by age group (children vs adults) and geographic region were performed to explore heterogeneity.
Main outcomes and measures: To estimate the proportion of AED-associated SJS/TEN.
Results: This systematic review and meta-analysis included 50 studies with 4403 patients that reported patient-level triggers of SJS/TEN. Single-drug triggers accounted for 88% (95% CI, 83-92) of cases. The pooled proportion of SJS/TEN cases attributed to AEDs was 23% (95% CI, 19-26). Nearly all AED-associated cases were…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 4,403 participants or records.
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