This systematic review and meta-analysis evaluated the proportion of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) cases attributable to antiepileptic drugs (AEDs), with subgroup analyses by age group (children vs. adults) and geographic region, across 50 studies (n=4,403) from MEDLINE and Embase (inception through March 17, 2026).
AEDs accounted for 23% (95% CI, 19–26%) of SJS/TEN cases worldwide; nearly all were caused by aromatic AEDs (96%), led by carbamazepine (39%), phenytoin (19%), and lamotrigine (15%). Children had a higher proportion than adults (35% vs. 23%), and regional variation ranged from 42% in West Asia to 10% in Africa.
- Pooled from observational studies only, limiting causal inference. - Significant heterogeneity across geographic regions may reduce generalizability. - Restricted to English-language publications, risking language bias.
Aromatic AEDs — especially carbamazepine, phenytoin, and lamotrigine — are the dominant drug triggers of SJS/TEN; clinicians should favor nonaromatic AEDs when therapeutically equivalent options exist, particularly in children who face a disproportionately higher risk.
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