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July 2018

Avoidance of Severe Cutaneous Adverse Drug Events as a First Step in Precision Neurology

Author Affiliations
  • 1Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China
  • 2DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, Florida
  • 3Cancer Epidemiology Program, Moffitt Cancer Center, Tampa, Florida
  • 4University of South Florida Colleges of Medicine and Pharmacy, Tampa, Florida
  • 5Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida
  • 6Individualized Cancer Management, Moffitt Cancer Center, Tampa, Florida
JAMA Neurol. 2018;75(7):793-795. doi:10.1001/jamaneurol.2018.0001

Progress in drug development has brought a host of novel agents for the treatment of neurological disorders ranging from multiple sclerosis to chronic pain.1 However, the treatment of most neurological disorders is still dependent on older medications. This includes medications, such as carbamazepine, with clinical activity across a broad number of disorders. Carbamazepine was first approved in 1963 for the treatment of epilepsy but has been used for treating types of schizophrenia, bipolar disorder, neuropathic pain, tinnitus, and trigeminal neuralgia. Although this agent is safe and effective for many patients, there is a low but persistent incidence of severe cutaneous adverse drug reactions (cADRs), including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms, and hypersensitivity syndrome.2 Data from the US Food and Drug Administration between 2004 and 2013 found an annual SJS/TEN incidence of 1 to 5 cases per 1 million persons in the United States.3 In addition, SJS/TEN is associated with a prolonged length of hospital stay and higher costs of care (SJS, 9.8 days, $21 437; SJS/TEN, 16.5 days, $58 954; TEN, 16.2 days, $53 695) compared with all other admissions (4.7 days, $11 281).4 This raises a challenge of how to use a medication that is safe for most patients but that also carries a risk of extreme morbidity or even mortality.