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Table 2 Strontium ranelate–induced severe cutaneous adverse reactions

From: 7th drug hypersensitivity meeting: part one

Region

Asia

Europe

Case series

This study

Tan et al. [1]/Lee et al. [2]

Cacoub et al. [3]

Country

Taiwan and Hong Kong

Singapore

France etc.

Culprit anti-osteoporotic agent

SR1

SR

SR

Indication to anti-osteoporotic agent

OPO

PM OPO2

OPO

Patients’ profile

 Ethnicity

Chinese

Chinese

Caucasian

 Gender

F (83.3)

F (100.0)

F (100.0)

 Average age (year)

64.7

69.5

68.7 (in DRESS group)

No. of SCARs patients

7

2

52

Phenotype

 SJS/TEN3

  Total case no.

6 (85.7)

2 (100.0)

5 (9.6)

  Average latent period (days)

29.2

16

Not mentioned

  Eye involvementa

1 (16.7)

1 (50)

Not mentioned

  Orogenital involvement

5 (83.3)

2 (100.0)

Not mentioned

 DRESS4

  Total case No.

1 (14.3)

0

47(90.4)

  Average latent period (days)

90.0

0

33.5

  Liver involvementb

0 (0)

0 (0)

37 (79.0)

  Kidney involvementc

0 (0)

0 (0)

12 (25.0)

  Eosinophiliad

1 (100.0)

0 (0)

43 (91.0)

Clinical sequelae

Nil

Nil

Persistent DRESS symptoms (21.3) and relapse of DRESS (2.0)

Mortality rate

0 %

0 %

8.5 % (in DRESS group)

  1. Abbreviations: 1 SR Strontium ranelate, 2 PM OPO postmenopausal osteoporosis, 3 SJS/TEN Stevens–Johnson syndrome/toxic epidermal necrolysis, 4 DRESS drug rash with eosinophilia and systemic symptoms
  2. *data are n(%) of patients unless otherwise specified
  3. aEye involvement: corneal ulcer or symblepharon, b Liver involvement: twofold increase from normal or baseline levels of serum glutamic oxaloacetic transaminase (GOT),glutamic pyruvate transaminase (GPT) or total bilirubin
  4. cKidney involvement: >1.5-fold elevation of serum creatinine from the normal range
  5. dEosinophilia: eosinophils count >500/μL
  6. References
  7. 1. Tan KW, Wang YS, Tay YK. Stevens–Johnson syndrome due to strontium ranelate. Ann Acad Med Singap. 2011;40(11):510–1.
  8. 2. Lee HY, et al. Strontium ranelate-induced toxic epidermal necrolysis in a patient with post-menopausal osteoporosis. Osteoporos Int. 2009;20(1):161–2.
  9. 3. Cacoub P, et al. Drug rash with eosinophilia and systemic symptoms (DRESS) in patients receiving strontium ranelate. Osteoporos Int. 2013;24(5):1751–7.
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