The clinical utility of laboratory monitoring during isotretinoin therapy for acne and changes to monitoring practices over time - 11/12/19
, Daniel B. Shin, PhD a, Shiyu Wang, MS a, David J. Margolis, MD, PhD a, b, Junko Takeshita, MD, PhD, MSCE a, bAbstract |
Background |
As a result of concerns about hypertriglyceridemia, liver enzyme abnormalities, and leukopenia during isotretinoin therapy for acne, patients are often monitored closely with routine laboratory assessments, although the value of this practice has been questioned.
Methods |
We conducted a cohort study of patients receiving isotretinoin for acne between January 1, 2008, and June 30, 2017, using the OptumInsights Electronic Health Record Database (Optum, Eden Prairie, MN) to evaluate the frequency of laboratory abnormalities. Poisson regression was used to evaluate for changes to the frequency of routine laboratory monitoring over time.
Results |
Among 1863 patients treated with isotretinoin, grade 3 or greater triglyceride and liver function testing abnormalities were noted in fewer than 1% and 0.5% of patients screened, respectively. No grade 3 or greater cholesterol or complete blood count abnormalities were observed. There were no meaningful changes in the frequency of laboratory monitoring over time.
Limitations |
Limitations include that we are unable to evaluate the clinical notes to understand the exact clinical decision making when clinicians encountered abnormal laboratory values.
Conclusion |
Although laboratory abnormalities are rare and often do not influence management, frequent laboratory monitoring remains a common practice. There are opportunities to improve the quality of care among patients being treated with isotretinoin for acne by reducing the frequency of lipid and liver function monitoring and by eliminating complete blood count monitoring.
Le texte complet de cet article est disponible en PDF.Key words : acne, adverse events, complete blood count, cost-effectiveness, hepatic, isotretinoin, lab, laboratory, liver, monitoring, temporal trends, triglycerides, value, white blood cell
Abbreviations used : ALT, AST, CI, IRR, WBC
Plan
| Funding sources: Funded in part through National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) grant 1P30-AR-069589-01. Dr Barbieri is supported by the NIAMS of the National Institutes of Health under award number T32-AR-007465 and receives partial salary support through a Pfizer Fellowship in Dermatology Patient Oriented Research grant to the Trustees of the University of Pennsylvania. Dr Takeshita is supported by NIAMS K23-AR-068433. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. |
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| Conflicts of interest: Dr Takeshita receives a research grant from Pfizer Inc (to the Trustees of the University of Pennsylvania) for work that is unrelated to this study and has received payment for continuing medical education work related to psoriasis that was supported indirectly by Eli Lilly and Novartis. Dr Barbieri, Dr Shin, Shiyu Wang, and Dr Margolis, have no conflicts of interest to disclose. |
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| Reprints not available from the authors. |
Vol 82 - N° 1
P. 72-79 - janvier 2020 Retour au numéro
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