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Journal of the American Academy of Dermatology
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le mercredi 6 novembre 2019
Doi : 10.1016/j.jaad.2019.06.025
accepted : 12 June 2019
The clinical utility of laboratory monitoring during isotretinoin therapy for acne and changes to monitoring practices over time
 

John S. Barbieri, MD, MBA a, , Daniel B. Shin, PhD a, Shiyu Wang, MS a, David J. Margolis, MD, PhD a, b, Junko Takeshita, MD, PhD, MSCE a, b
a Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 
b Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 

Correspondence to: John S. Barbieri, MD, MBA, PCAM 7 South Tower, 3400 Civic Center Blvd, Philadelphia, PA 19104.PCAM 7 South Tower, 3400 Civic Center BlvdPhiladelphiaPA19104
Abstract
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.

The full text of this article is available in PDF format.

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



 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.
 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.
 Reprints not available from the authors.



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