Consensus on isotretinoin laboratory monitoring in acne treatment

Reuters Health - 23/06/2022 - An international panel of dermatologist acne experts has reached consensus on a core set of laboratory tests that should be evaluated before and during treatment with isotretinoin.

"Although isotretinoin may rarely be associated with laboratory abnormalities such as hypertriglyceridemia, the optimal approach to laboratory monitoring is uncertain, and there is wide variation in clinical practice," the panel notes in JAMA Dermatology.

The panel of 22 experts from five continents reached consensus (70% or higher agreement) on the following:

- Checking alanine aminotransferase within a month prior to initiation (89.5% agreement) and at peak dose (89.5% agreement), but not monthly (76.2%) or after treatment completion (73.7%).

- Checking triglycerides within a month prior to initiation (89.5%) and at peak dose (78.9%) but not monthly (84.2%) or after treatment completion (73.7%).

- Not checking complete blood cell count or basic metabolic-panel parameters at any point during isotretinoin treatment (all >70%).

- Not checking gamma-glutamyl transferase (78.9%), bilirubin (81.0%), albumin (72.7%), total protein (72.7%), low-density lipoprotein (73.7%), high-density lipoprotein (73.7%), or C-reactive protein (77.3%).

"Although there are existing guidelines for the management of acne, such as the American Academy of Dermatology work group guidelines released in 2016 and the NICE guideline published in 2021, the specific recommendations surrounding laboratory monitoring frequency are nonstandardized and often nonspecific," the panel says.

"Given the wide variation in practice patterns, these results provide data to guide clinical practice and guideline development to optimize laboratory monitoring for patients treated with isotretinoin for acne," they add.

They say additional research is needed to determine best practices for laboratory measures that did not reach consensus, such as the uncertain clinical value of monitoring alanine aminotransferase (AST), alkaline phosphatase and creatine kinase and total cholesterol.

The panel says their consensus is intended to "guide appropriate clinical decision-making."

"Although our recommendations cannot replace clinical judgement based on the unique circumstances of individual patients, we believe they provide a framework for management of a typical, otherwise healthy patient being treated with isotretinoin for acne. More routine monitoring, or reduced monitoring, should be considered on a case-by-case basis accounting for the unique medical history, circumstances, and baseline abnormalities, if present, of each patient," they write.

SOURCE: https://bit.ly/3Od0wYz JAMA Dermatology, online June 15, 2022.

By Reuters Staff



Posted on 23 June 202215 July 2022