The Prevalence of Stevens–Johnson Syndrome Complications due to Antiepileptic Drug Use: A Systematic Review and Meta‑Analysis

Abstract

Background: Stevens–Johnson syndrome (SJS) as a dermatological emergency, is a severe condition with a 5% mortality rate. Antiepileptic drugs (AEDs) are linked to an increased risk of SJS, but the magnitude of this risk varies between studies, so comprehensive investigations are needed to evaluate the prevalence of SJS complications associated with AEDs. Methods: Based on PRISMA guidelines, Online databases including PubMed/Medline, CINAHL (EBSCO), Web of Science (ISI), Scopus, and Embase were searched using related MeSH‑term. Studies reporting SJS as a complication of AEDs or considering AEDs suspected of inducing SJS were included. The Studies which not published in English mentioned other complications instead of skin manifestations were excluded. The data was analyzed using the STATA 14 software. To investigate heterogeneity, the Q Cochrane test and I2 test were used, and the random effects model was used for combining articles. Results: Of 1630 studies, 24 studies were included in meta‑analysis. The overall pooled prevalence of SJS was 23.22% (95% CI: 17.32–29.11). The pooled prevalence of SJS was 22.56% (95% CI: 16.55–28.57) in the Retrospective Cohort; 30.90% (95% CI: 5.32–56.48) in perspective Cohort, 24.84% (95% CI: 18.02–31.67) in Asia, 11.20% (95% CI: 6.10–18.4) in America, and 11.70% (95% CI: 2.77– 20.63) in Europe. The I2 index for the overall pooled prevalence of SJS was 93.6%. The results of the meta‑regression exhibited that the sample size, publication year, age, design study, and place showed no significant effect on heterogeneity (P > 0.05). This review found a significant prevalence of Stevens–Johnson syndrome (SJS) linked to antiepileptic drugs (AEDs) at 23.22%. Conclusions: Clinicians should be cautious when prescribing AEDs, especially to high‑risk populations. More research is needed to understand SJS mechanisms and identify genetic markers for personalized treatment approaches.