From the Guidelines
Icosapent ethyl may help necrolytic epidermal necrolysis (TEN) through its anti-inflammatory and immunomodulatory properties, as evidenced by its ability to reduce pro-inflammatory cytokines and inhibit the production of inflammatory mediators, as seen in the REDUCE-IT trial 1.
Key Points
- Icosapent ethyl works by reducing pro-inflammatory cytokines and inhibiting the production of inflammatory mediators that contribute to the severe skin reactions seen in TEN.
- The medication also helps maintain skin barrier integrity by promoting cell membrane stability and reducing oxidative stress.
- While not a first-line treatment for TEN, icosapent ethyl could be considered as an adjunctive therapy at doses of 2-4 grams daily, divided into two doses.
- Treatment would typically continue through the acute phase of TEN until clinical improvement is observed.
- Management of TEN primarily involves discontinuation of the causative drug, supportive care, and possibly systemic immunomodulatory therapies like cyclosporine or IVIG, as outlined in the UK guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 2016 1.
Considerations
- Icosapent ethyl should be used as part of a comprehensive treatment approach under specialist supervision.
- The medication has been shown to be generally well-tolerated, with a trend toward more bleeding-related disorders, but this did not reach statistical significance 1.
- The explanation for the highly beneficial observed outcomes is unclear, but it is unlikely that the benefit was a function of baseline triglyceride levels, as reduction in risk of achieving either the primary or secondary efficacy composite endpoint was the same in those with baseline triglycerides ≥200 mg/dL and those with values <150 mg/dL 1.
From the Research
Icosapent Ethyl and Necrolytic Epidermal Necrolysis
- There is no direct evidence in the provided studies that explains how icosapent ethyl helps with necrolytic epidermal necrolysis.
- The studies provided focus on different aspects of skin disorders, such as necrolytic migratory erythema 2, 3, toxic epidermal necrolysis 4, 5, 6, and their treatments.
- Necrolytic migratory erythema is associated with glucagonoma syndrome, which is characterized by a skin disorder, weight loss, and diabetes mellitus 2, 3.
- Toxic epidermal necrolysis is a rare, life-threatening, drug-induced cutaneous reaction, and its treatment may involve high-dose intravenous immunoglobulin and immunomodulating systemic therapy 4, 5, 6.
- The use of icosapent ethyl in the treatment of necrolytic epidermal necrolysis is not mentioned in the provided studies, suggesting that there may be a lack of research on this specific topic 2, 4, 5, 3, 6.