Outcomes of ciclosporin treatment in paediatric patients with drug reaction with eosinophilia and systemic symptoms (DRESS): a retrospective cohort analysis

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but severe hypersensitivity reaction. In this retrospective cohort study, we compared the efficacy of systemic corticosteroids, the current first-line treatment, with ciclosporin, a treatment that is increasingly being used in paediatric patients with DRESS. We analysed the cases of 14 paediatric patients (aged < 18 years) admitted to the hospital between January 2016 and September 2023. Five patients received ciclosporin, while nine were treated with systemic corticosteroids. Ciclosporin treatment was associated with shorter hospital stays (median 6 days vs. 9 days) and more rapid normalization of alanine aminotransferase levels (25 days vs. 40 days) compared with corticosteroid treatment. While ciclosporin was well-tolerated, corticosteroid treatment was linked to adverse events, including corticosteroid-induced diabetes (n = 2), disease flares during tapering (n = 3) and the need for treatment intensification (n = 2). These findings suggest that ciclosporin may be a promising treatment for managing paediatric DRESS.