ArticleNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2025
Risk factors and predictive score for phenytoin-induced cutaneous reactions.
Article in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPhenytoin continues to be widely used in a number of countries as an antiseizure medication despite the introduction of newer agents. However, cutaneous adverse drug reactions (CADRs) associated with phenytoin remain a significant clinical concern, with manifestations ranging from mild maculopapular rashes to severe, life-threatening dermatological conditions.
objectiveThis study aimed to evaluate clinical risk factors and develop a clinical prediction score for phenytoin-induced CADRs in hospitalized patients.
methodsA retrospective cohort study included 447 patients aged ≥ 15 years who received phenytoin for the first time and were followed for at least 12 weeks. Data on demographics, clinical characteristics, comorbidities, concomitant drugs, and CADR occurrence were collected. Logistic regression identified independent risk factors, and a clinical prediction score was developed and evaluated using the area under the receiver operating characteristic curve (AuROC).
resultsForty-seven (10.5%) patients developed CADRs. Multivariable analysis identified malignancy (adjusted OR = 6.27), HIV infection (adjusted OR = 47.1), alcohol dependence (adjusted OR = 37.14), concomitant diazepam use (adjusted OR = 11.07), and concomitant carbapenem use (adjusted OR = 9.88) as independent risk factors. The prediction score exhibited good discrimination with an AuROC of 0.856 (95% CI: 0.790-0.922). Internal validation yielded a consistent AuROC of 0.896 (95% CI: 0.836-0.955).
conclusionThis study developed a clinical prediction score for phenytoin-induced CADRs in hospitalized patients, demonstrating good predictive ability using readily available clinical factors. This tool may help clinicians identify high-risk individuals for closer monitoring. External validation through prospective studies is needed to confirm its clinical utility.
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