Risk of antiepileptic medications inducing drug reaction with eosinophilia and systemic symptoms syndrome

Summary: Abstract Body: Aromatic antiepileptic drugs are noted to be a leading cause of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. However, the risk of these medications and general antiepileptics remains unquantified in patients with a history of epilepsy. Utilizing the US Collaborative Network TriNetX and International Classification of Disease (ICD)-10 codes, sixteen cohorts of patients with a history of epilepsy and exposure to antiepileptic medications were created. Each cohort was excluded from exposure to the other measured medications, as well as a history of neuralgia, restless leg syndrome, migraines, and bipolar disorder. The cohorts were matched against a control group, evaluated for the outcome of DRESS syndrome within a 2-8 week period, and a hazard ratio (HR) with 95% confidence intervals (CI) was calculated. When compared to the control group, lamotrigine (HR=3.477, 95% CI [1.416,8.538]), lorazepam (HR=2.033, 95% CI [1.094,3.779), lacosamide (HR=2.836, 95% CI [1.031,7.802], and phenytoin (HR=6.515, 95% CI [1.47,28.868]) showed a statistically significant increased risk for DRESS syndrome. However, the other measured antiepileptics did not show an increased risk. This study highlights the ability of a database study to further support or refute data reported in case report or case series studies. Additional studies evaluating other reported medications associated with DRESS syndrome should be conducted. Megan Bradley¹, Alyssa Hansen², Michael G. Wilkerson² 1. John Sealy School of Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX, United States. 2. Department of Dermatology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States. Clinical Research: Epidemiology and Observational Research