Dapsone‐induced agranulocytosis: symptoms may alert more reliably than the current blood monitoring protocol

Claire, Kayla St; Kaul, Subuhi; Caldito, Elena Gonzalez; Kramer, Owen N.; Griffin, Tina; Albrecht, Joerg

doi:10.1111/bjd.19708

Cited by 3 publications

(3 citation statements)

References 5 publications

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“…sore throat, fever, severe malaise) rather than to monitor blood at monthly intervals. For dapsone, even weekly monitoring has been insufficient to prevent lethal agranulocytosis‐induced sepsis, and dapsone, or even terbinafine, has more reports of agranulocytosis than isotretinoin has 59 . In addition no death due to haematological disorders has been reported in the UK 25…”

Section: Methodsmentioning

confidence: 99%

Is routine laboratory testing in healthy young patients taking isotretinoin necessary: a critically appraised topic

Affleck

Jackson

Williams

et al. 2022

British Journal of Dermatology

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Summary Clinical question Is monitoring of liver function, lipids and full blood count necessary in healthy people taking isotretinoin? Background Routine blood testing was recommended in the original licence for Roaccutane™ (isotretinoin) in 1983. In recent years, less frequent monitoring has been suggested by various authors. Data sources We performed four individual systematic searches of the MEDLINE database, via PubMed, from origin to 2 May 2021, supplemented by a hand search of all references in the identified papers. Study selection Inclusion criteria were any description of clinical symptoms, laboratory abnormalities and/or physical findings, and any paper that explicitly described the patients as asymptomatic, during treatment with oral isotretinoin. Data extraction Two independent reviewers (J.A. and D.J.) assessed articles for eligibility of inclusion. Evaluation of the data was done also by two of the authors (A.A., D.J. and J.A.) for each section, with the aim to use the presented evidence including guidelines, databases, case series, case reports, cohort studies and randomized clinical trials to delineate the clinical presentation and frequency of adverse events that might be amenable to laboratory monitoring. Results We identified 407 papers in our searches and reviewed 125 papers in four sections. Overall, reported adverse events were very rare (< 1 in 10 000) and were either idiosyncratic or not preventable by monitoring, accompanied by symptoms, or seen in identifiable predisposed individuals who might benefit from monitoring because of pre‐existing conditions. Recommendation for clinical care We could not find evidence to support the benefit of monitoring to detect adverse events. We suggest that in healthy young people laboratory monitoring for oral isotretinoin is unnecessary and risks detecting nonserious biochemical abnormalities. However, we recognize that new information about adverse events may change that recommendation.

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Section: Methodsmentioning

confidence: 99%

Is routine laboratory testing in healthy young patients taking isotretinoin necessary: a critically appraised topic

Affleck

Jackson

Williams

et al. 2022

British Journal of Dermatology

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“…Leukopenia, anemia, and thrombocytopenia have also been reported 33 . If trimethoprim‐sulfamethoxazole toxicity is suspected, the drug can be substituted with pentamidine, atovaquone, or dapsone, although dapsone is also associated with a rare and idiosyncratic but serious neutropenia risk 41,42 …”

Section: Epidemiology and Etiology Of Neutropenia After Solid Organ T...mentioning

confidence: 99%

“…33 If trimethoprim-sulfamethoxazole toxicity is suspected, the drug can be substituted with pentamidine, atovaquone, or dapsone, although dapsone is also associated with a rare and idiosyncratic but serious neutropenia risk. 41,42 Valganciclovir, a prodrug of ganciclovir, may be used for cytomegalovirus prophylaxis or treatment after solid organ transplant.…”

Section: Ta B L E 1 Classification Of Severity Of Neutropeniamentioning

confidence: 99%

Neutropenia in pediatric solid organ transplant

Harshman

Williams

Engen

2022

Pediatric Transplantation

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Neutropenia is generally defined as an absolute neutrophil count in the circulation of less than 1500/mm3 and occurs in up to 25%–30% of pediatric solid organ transplant recipients (SOT) within the first year after transplantation. In the SOT population, neutropenia is most often a result of drug‐induced bone marrow suppression but can also be secondary to viral infection, nutritional deficiencies, lymphoproliferative infiltrate, and inherited causes. Outcomes for patients with neutropenia vary by degree of neutropenia and type of solid organ transplant. Management of neutropenia should begin by addressing the underlying cause, including reducing or removing medications when appropriate, treating infections, and addressing nutrient deficiencies; however, consultation with an experienced pediatric hematologist and use of granulocyte colony‐stimulating factor (G‐CSF) may be helpful in some cases. Overall, data on clinical outcomes for G‐CSF use remain limited, but observational studies may support its use in patients with infections or severe neutropenia.

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Dapsone for the treatment of acne vulgaris: do the risks outweigh the benefits?

Temiz

Daye

2022

Cutaneous and Ocular Toxicology

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Dapsone‐induced agranulocytosis: symptoms may alert more reliably than the current blood monitoring protocol

Cited by 3 publications

References 5 publications

Is routine laboratory testing in healthy young patients taking isotretinoin necessary: a critically appraised topic

Is routine laboratory testing in healthy young patients taking isotretinoin necessary: a critically appraised topic

Neutropenia in pediatric solid organ transplant

Dapsone for the treatment of acne vulgaris: do the risks outweigh the benefits?

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