A Cautionary Tale of Criteria Based on Anecdotal Evidence With Etanercept in Toxic Epidermal Necrolysis

To the Editor: A case series by Faris et al1 describes three patients with toxic epidermal necrolysis treated with etanercept. For the authors to implicate an association between etanercept use and fatality, the evidence must be complete and compelling. First, the authors did not report SCORTEN, a severity index score used to calculate the probability of death based on seven risk factors.2 Without this crucial information, no conclusions can be drawn about the impact of etanercept on their outcomes. Furthermore, each patient failed other monotherapies prior to etanercept, suggesting severe disease with a high likelihood of death despite aggressive treatment.2 While treatment with etanercept imparts increased risk for serious infections, it is unlikely that Patient 1 developed sepsis related to etanercept within 24 hours of starting treatment. When etanercept was initiated, Patient 2 was already in critical condition. Her continued deterioration simply shows etanercept had no meaningful...