1. The Australasian Registry for Severe Cutaneous Adverse Reactions (AUS-SCAR) – Providing a roadmap for closing the diagnostic, patient, and healthcare gaps for a group of rare drug eruptions
- Author
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Fiona James, BBiomedSci, Michelle S. Goh, MBBS, Sara Vogrin, MBiostat, Irvin Ng, PhD, Abby P. Douglas, PhD, Natasha E. Holmes, PhD, Kyra YL. Chua, PhD, Joseph De Luca, MBBS, Pooja Sharma, MD, Celia Zubrinich, MPhil, Ar K. Aung, MBBS, Douglas Gin, MBBS, Belinda Lambros, MAdvNursPrac, Chris Baker, MBBS, Peter Foley, MD, Alvin H. Chong, MMed, Francis Thien, MD, Jie S. Fok, MBBS, John Su, MBBS, Laura Scardamaglia, MBBS, Andrew Awad, MD, Steven Tong, PhD, Douglas Johnson, PhD, Jack Godsell, MBBS, Alexis Arasu, MBBS, Sara Barnes, MBA, Samar Ojaimi, PhD, Adrian Mar, MBBS, James Yun, PhD, Nikhita Ange, MBBCh, Winnie W.Y. Tong, PhD, Andrew Carr, DSc, Jacqueline Loprete, PhD, Constance H. Katelaris, PhD, Dana Slape, MBBS, Karuna Keat, MBBS, Timothy A. West, MBBS, Monique Lee, MBBS, William Smith, PhD, Pravin Hissaria, MD, Shireen Sidhu, MBBS, Sonja Janson, MBBS, Sudharsan Venkatesan, MBBS, Jane Davies, PhD, Michael J. Lane, MBBS, Andrew M. Redmond, MBBS, Ivan Robertson, MBBS, Amy Legg, GradDipClinPharm, Suran Fernando, PhD, Therese Boyle, MA, Jamma Li, MPhil, Elizabeth J. Phillips, MD, Heather Cleland, MBBS, Johannes S. Kern, MD, and Jason A. Trubiano, PhD
- Subjects
Delayed hypersensitivity ,T-cell mediated hypersensitivity ,Stevens-Johnson syndrome ,Toxic epidermal necrolysis ,Acute generalized exanthematous pustulosis ,Drug reaction with eosinophilia and systemic symptoms ,Immunologic diseases. Allergy ,RC581-607 - Abstract
Background: Severe cutaneous adverse reactions (SCAR) are a group of delayed presumed T-cell mediated hypersensitivities associated with significant morbidity and mortality. Despite their shared global healthcare burden and impact, the clinical phenotypes, genomic predisposition, drug causality, and treatment outcomes may vary. We describe the establishment and results from the first Australasian registry for SCAR (AUS-SCAR), that via a collaborative network advances strategies for the prevention, diagnosis and treatment of SCAR. Methods: Prospective multi-center registry of SCAR in Australian adult and adolescents, with planned regional expansion. The registry collects externally verified phenotypic data drug causality, therapeutics and long-term patient outcomes. In addition, biorepository specimens and DNA are collected at participating sites. Results: we report on the first 100 patients enrolled in the AUS-SCAR database. DRESS (50%) is the most predominant phenotype followed by SJS/TEN (39%) and AGEP (10%), with median age of 52 years old (IQR 37.5, 66) with 1:1 male-to-female ratio. The median latency for all implicated drugs is highly variable but similar for DRESS (median 15 days IQR 5,25) and SJS/TEN (median 21 days, IQR 7,27), while lowest for AGEP (median 2.5 days, IQR 1,8). Antibiotics (54.5%) are more commonly listed as primary implicated drug compare with non-antibiotics agent (45.5%). Mortality rate at 90 days was highest in SJS/TEN at 23.1%, followed by DRESS (4%) and AGEP (0%). Conclusion: In the first prospective national phenotypic and biorepository of SCAR in the southern hemisphere we demonstrate notable differences to other reported registries; including DRESS-predominant phenotype, varied antibiotic causality and low overall mortality rate. This study also highlights the lack of standardised preventative pharmacogenomic measures and in vitro/in vivo diagnostic strategies to ascertain drug causality. Trial registration: ANZCTR ACTRN12619000241134. Registered 19 February 2019.
- Published
- 2024
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