Isotretinoin Laboratory Monitoring in Acne Treatment

Abstract

ImportanceAlthough 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.ObjectiveTo establish a consensus for isotretinoin laboratory monitoring among a diverse, international cohort of clinical and research experts in acne.Design, Setting, and ParticipantsUsing a modified electronic Delphi process, 4 rounds of anonymous electronic surveys were administered from 2021 to 2022. For laboratory tests reaching consensus (≥70% agreement) for inclusion, questions regarding more time-specific monitoring throughout isotretinoin therapy were asked in subsequent rounds. The participants were international board-certified dermatologist acne experts who were selected on a voluntary basis based on involvement in acne-related professional organizations and research.Main Outcomes and MeasuresThe primary outcome measured was whether participants could reach consensus on key isotretinoin laboratory monitoring parameters.ResultsThe 22 participants from 5 continents had a mean (SD) time in practice of 23.7 (11.6) years and represented a variety of practice settings. Throughout the 4-round study, participation rates ranged from 90% to 100%. Consensus was achieved for the following: check alanine aminotransferase within a month prior to initiation (89.5%) and at peak dose (89.5%) but not monthly (76.2%) or after treatment completion (73.7%); check 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%); do not check complete blood cell count or basic metabolic panel parameters at any point during isotretinoin treatment (all >70%); do not check 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%).Conclusions and RelevanceThis Delphi study identified a core set of laboratory tests that should be evaluated prior to and during treatment with isotretinoin. These results provide valuable data to guide clinical practice and clinical guideline development to optimize laboratory monitoring in patients treated with isotretinoin.

The efficiency and safety of low‐dosage isotretinoin therapy for Chinese acne vulgaris patients

“…Laboratory investigations including serum total cholesterol, triglyceride level (TG), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and low‐density lipoprotein (LDL) were evaluated at the baseline, once a month for the first 3 months, and then once every 3 months till the therapy was finished. Routine complete blood cell counts were not monitored in this study because they were not recommended 9 . Female patients were advised of contraception, and pregnancy tests were performed in suspected cases before treatment.…”

“…Routine complete blood cell counts were not monitored in this study because they were not recommended. 9 Female patients were advised TA B L E 1 Basic demographics of patients and response to therapy.…”

Monitoreo de laboratorio en pacientes bajo tratamiento con isotretinoina: ¿es necesario realizarlo de forma continua?

“…¿Será necesario realizarlo de forma continua? (3) Muy recientemente, fue publicado un estudio de consenso tipo Delphi realizado por Xia et al , donde los autores administraron una encuesta anónima 4 veces de forma electrónica a 22 dermatólogos certificados internacionalmente y expertos en acné severo (tiempo promedio de experiencia médica de 23 años), provenientes de 5 continentes, sobre el tiempo de monitoreo específico de parámetros de laboratorio durante el uso de isotretinoina. Se evidenció que 89,5% consensuaron evaluar la alanina aminotransferasa tanto un mes previo al inicio del tratamiento como en el pico de la dosis, pero no mensualmente (76,2%) o posterior a finalizar el tratamiento (73,7%).…”

Isotretinoin: 40 years of experience

“…Značajan poremećaj lipida i funkcije jetre (nivo 3 ili viši prema Cancer Institute Common Terminology Criteria for Adverse Events -CTCAE sistemu gradiranja toksičnosti) u ovoj kohorti zabeležen je kod manje od 1% i 0,5% pacijenata, respektivno. Poslednji Delfi konsenzus u vezi sa laboratorijskim monitoringom preporučio je merenje alanin aminotransferaze i triglicerida u toku mesec dana pre započinjanja terapije i nakon postizanja najviše dnevne doze leka, dok nije postignut konsenzus oko preporuka za merenje i praćenje kompletne krvne slike, vrednosti C reaktivnog proteina, gama glutamil transferaze, bilirubina, albumina, proteina, LDL i HDL frakcija lipoproteina 27 .…”