Original articleThe clinical utility of laboratory monitoring during isotretinoin therapy for acne and changes to monitoring practices over time
Section snippets
Study design and data source
We performed a cohort study using a 10% random sample of the OptumInsights Electronic Health Record database (Optum, Eden Prairie, MN) that included data from January 1, 2007, to June 30, 2017; this was the data set available to the investigators. The full data set includes deidentified data abstracted from the electronic medical records of more than 150,000 providers, 2000 hospitals, and 7000 clinics and is based on integrating data from the electronic medical record and other health
Cohort
The analysis included 1863 patients, and 49.0% were women. The median age was 18.2 years (interquartile range, 16.3-24.5 years). The median course duration for isotretinoin treatment was 148 days (interquartile range, 65-183 days) (Table II). Regional distribution of patients across the United States was 11.5% Northwest, 61.9% Midwest, 13.6% South, and 9.7% West.
Monitoring frequency and changes over time
In general, the absolute numbers of patients on therapy and, consequently, the absolute numbers of patients being monitored decreased
Discussion
In this cohort study of patients across the United States, clinically significant abnormalities for patients receiving isotretinoin for acne were rare and often did not result in changes in management. In particular, no significant WBC or platelet count abnormalities were noted. These findings are consistent with prior studies and suggest that extensive laboratory monitoring in this population may be of low value.5, 6, 7 In addition, changes to lipid levels observed in this study typically
Conclusions
Among acne patients undergoing treatment with isotretinoin, laboratory abnormalities are rare and often do not influence management. However, frequent laboratory monitoring remains a common practice, and the rate of laboratory monitoring has not decreased substantially over time. There are opportunities to improve the quality and cost of care by reducing the frequency of lipid and liver function monitoring and by eliminating the practice of complete blood count monitoring in this patient
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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.
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