Seasonality and Trends in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Before and During the COVID-19 Pandemic: A Pharmacovigilance Study.

IMPORTANCE

Seasonal variation in adverse drug reactions has clinical and mechanistic implications for understanding disease mechanisms and risk mitigation strategies. Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) is a life-threatening mucocutaneous reaction with high morbidity and mortality, which may have a seasonal component.

OBJECTIVE

To determine whether the reporting of SJS/TEN to the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) follows a seasonal pattern, incorporating both traditional seasonal analyses and time-series modeling.

DESIGN

Cross-sectional, population-based analysis of FAERS reports from January 2010 to December 2019. Seasonal differences were assessed using Kruskal-Wallis tests and Seasonal-Trend Decomposition using Loess (STL). Seasonal autoregressive integrated moving average (SARIMA) models were used to counterfactually forecast SJS/TEN and comparator conditions during the COVID-19 pandemic, assessing changes in reporting.

SETTING

Population-based analysis of spontaneous adverse event reports submitted to FAERS.

PARTICIPANTS

All deduplicated FAERS reports with complete event dates from 2010 to 2019 were included. SJS/TEN cases were identified using standardized MedDRA terms. Comparator analyses of known seasonal conditions - photosensitivity reactions, influenza, and respiratory syncytial virus (RSV) - served as positive controls.

EXPOSURES: Drug exposures as recorded in FAERS.

MAIN OUTCOMES AND MEASURES: The primary outcome was the monthly and seasonal proportion of unique SJS/TEN reports, normalized using all FAERS reports during a particular interval as the denominator. Seasonality strength was quantified from STL decomposition (range 0-1). SARIMA models were applied to pre-COVID data to counterfactually forecast trends from March 2020 to December 2023. Forecast accuracy was evaluated using mean squared error (MSE), root mean squared error (RMSE), and residual diagnostics.

RESULTS

Among 5,900 SJS/TEN cases reported from 2010-2019, no significant monthly or seasonal variation was detected (p > 0.05), and seasonality strength was low (0.163). Positive controls (influenza, RSV, photosensitivity) showed expected strong seasonality. SARIMA forecasts indicated a mild increase in SJS/TEN reporting during the pandemic, compared to its previous declining trend. Influenza and RSV dropped below predictions during the pandemic, while photosensitivity remained relatively consistent.

CONCLUSIONS AND RELEVANCE: SJS/TEN reporting to FAERS does not exhibit apparent seasonality, in contrast to positive controls. Time-series modeling confirmed these findings and highlighted the relative stability of SJS/TEN reporting during the pandemic compared to respiratory viruses.