APOA4 as a novel predictor of prognosis in Stevens-Johnson syndrome/toxic epidermal necrolysis: A proteomics analysis from two prospective cohorts.

Ting Gong, Peng Zhang, Shi-Fan Ruan, Zhixun Xiao, Wen Chen, Min Lin, Qingmei Zhong, Renwei Luo, Qiuyun Xu, Jiamei Peng, Bo Cheng, Fa Chen, Lihong Chen, Wen-Hung Chung, Chao Ji

Journal of the American Academy of Dermatology 2023 Jul

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Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but life-threatening adverse drug reactions. Conventional systemic therapies are of limited efficacy and often exhibit strong side effects. To assess the efficacy and safety of the combination treatment with a tumor necrosis factor-α antagonist adalimumab and delineate the underlying mechanisms. We evaluated the efficacy and safety of the combination therapy with adalimumab by comparing 2 treatment cohorts of SJS/TEN patients. Patient plasma samples were collected for proteomics analysis. The combination therapy with adalimumab significantly shortened the time to mucocutaneous re-epithelization and healing, with reduced side effects caused by corticosteroids. Plasma proteomic profiling showed that apolipoprotein A-IV (APOA4) was one of the most significant differentially expressed proteins. Multivariate regression analysis revealed that APOA4 level was significantly associated with prognosis parameter of SJS/TEN (P = .004), but not with disease severity score (severity-of-illness score for toxic epidermal necrolysis [SCORTEN]) (P = .118). Thus further research will be helpful to effectively incorporate APOA4 into current SCORTEN-driven protocols. The cohort size is relatively small. Both cohorts had low overall SCORTEN scores. Adalimumab in combination with corticosteroids demonstrates significant clinical benefits over corticosteroids alone in SJS/TEN patients. Moreover, APOA4 may serve as a novel prognostic marker of SJS/TEN. Copyright © 2023 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Citation

Ting Gong, Peng Zhang, Shi-Fan Ruan, Zhixun Xiao, Wen Chen, Min Lin, Qingmei Zhong, Renwei Luo, Qiuyun Xu, Jiamei Peng, Bo Cheng, Fa Chen, Lihong Chen, Wen-Hung Chung, Chao Ji. APOA4 as a novel predictor of prognosis in Stevens-Johnson syndrome/toxic epidermal necrolysis: A proteomics analysis from two prospective cohorts. Journal of the American Academy of Dermatology. 2023 Jul;89(1):45-52