Psychiatric disorders and suicidal behavior in patients with acne prescribed oral antibiotics versus isotretinoin: Analysis of a large commercial insurance claims database

Ugonabo, Nkemjika; Love, Elyse; Wong, Priscilla W.; Rieder, Evan A.; Orlow, Seth J.; Kim, Randie H.; Nagler, Arielle R.

doi:10.1016/j.jaad.2021.01.107

Cited by 17 publications

(25 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, a contrasting, statistically nonsignificant association was observed when the isotretinoin‐exposed cohort were compared with those with prescriptions for oral antibiotics (OR 0·85, 95% CI 0·66–1·11). This finding is also in line with previous observational research concluding that isotretinoin is unlikely to be independently associated with self‐harm at population level 21,24 . Furthermore, our finding that patients treated with oral antibiotics had a significantly increased odds for nonfatal self‐harm compared with those prescribed topical anti‐acne agents (OR 1·24, 95% CI 1·03–1·51) is consistent with previous work showing that the risk of self‐harm was already increased in patients with acne before isotretinoin treatment 25 .…”

Section: Discussionsupporting

confidence: 92%

“…This finding is also in line with previous observational research concluding that isotretinoin is unlikely to be independently associated with self-harm at population level. 21,24 Furthermore, our finding that patients treated with oral antibiotics had a significantly increased odds for nonfatal self-harm compared with those prescribed topical anti-acne agents (OR 1Á24, 95% CI 1Á03-1Á51) is consistent with previous work showing that the risk of self-harm was already increased in patients with acne before isotretinoin treatment. 25 Accumulating evidence, therefore, does not support the conclusion that isotretinoin would be independently associated with excess adverse neuropsychiatric outcomes at the population level.…”

Section: Discussionsupporting

confidence: 90%

See 1 more Smart Citation

Isotretinoin and adverse neuropsychiatric outcomes: retrospective cohort study using routine data*

et al. 2022

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

Isotretinoin and adverse neuropsychiatric outcomes: retrospective cohort study using routine data*

et al. 2022

View full text Add to dashboard Cite

show abstract

“…4,7,8 Patients prescribed isotretinoin are less likely to be diagnosed with suicidal ideation or attempt than the general population. 9 No direct causal link has been established between isotretinoin and depression/suicide in a global population, [10][11][12] but some clinical case reports [13][14][15] suggest a very rare, unpredictable and idiosyncratic reaction in vulnerable patients.…”

Section: Introductionmentioning

confidence: 99%

“…Some pharmacoepidemiological studies have found a significant association between isotretinoin and depression 5,6 but most studies have shown that on the contrary, isotretinoin improves depressive symptoms 4,7,8 . Patients prescribed isotretinoin are less likely to be diagnosed with suicidal ideation or attempt than the general population 9 . No direct causal link has been established between isotretinoin and depression/suicide in a global population, 10–12 but some clinical case reports 13–15 suggest a very rare, unpredictable and idiosyncratic reaction in vulnerable patients.…”

Section: Introductionmentioning

confidence: 99%

First use of the Adolescent Depression Rating Scale (ADRS) in the management of young people with severe acne treated with isotretinoin: a pilot study of an active monitoring of depressive disorders by dermatologists

Hefez¹,

Micallef

Révah-Lévy

et al. 2022

Clinical and Experimental Dermatology

View full text Add to dashboard Cite

Summary Background During isotretinoin treatment, special attention is required to detect any symptom or change in the mental health of patients. The monitoring is complex for adolescents because of confounding factors such as mood changes associated with adolescence and puberty and the higher psychosocial impairment due to the acne itself. Aim To determine the utility of the Adolescent Depression Rating Scale (ADRS) for monitoring symptoms in adolescents before and during isotretinoin treatment in dermatology real‐life practice. Methods This was a national, multicentre prospective study that enrolled a random sample of dermatologists treating adolescents. An algorithm including ADRS score and its changes between consecutive visits was used. At each visit, dermatologists rated their satisfaction with ADRS and its ease of use, while patients rated the acceptability of the ADRS. Results In total, 70 dermatologists used the algorithm for 1227 visits of 283 adolescents receiving isotretinoin. Of these 70 dermatologists, 80.8% were satisfied/very satisfied with the ADRS, 82.7% considered the use of the ADRS in clinical practice to be easy/very easy and 75% considered that the ADRS enabled them to discuss more easily the risk of depression with their patients. For the patients, acceptability of the ADRS was considered good by 93.8%. Conclusions The implementation of the ADRS could be valuable in dermatology practice, optimizing the monitoring of patients and the good use of isotretinoin.

show abstract

“…Other studies support the perspective that isotretinoin is not associated with higher rates of neuropsychiatric events at the population level. A very large US population study 4 and a recent meta‐analysis of 31 studies 5 showed no evidence to support an association between isotretinoin and depression. Singer et al 6 .…”

mentioning

confidence: 98%

Isotretinoin does not contribute to increased neuropsychiatric risk in the overall acne population, but risk management during treatment remains essential

Ravenscroft

Eichenfield

2022

Br J Dermatol

View full text Add to dashboard Cite

life, especially in patients with chronic HE (CHE). According to recently published guidelines for diagnosis, prevention and treatment of HE, topical corticosteroids are recommended as a short-term treatment for HE, as potent corticosteroids may cause skin atrophy and interfere with recovery in the long term. [2][3][4] The topical calcineurin inhibitor, tacrolimus, is also suggested for short-term treatment in patients with HE. In daily practice, it is used in patients refractory to topical corticosteroids, when fear of side-effects exists or in patients with CHE. 2 For severe CHE, alitretinoin is the only registered systemic drug in some countries. Consequently, there is a significant unmet need for effective and safe topical treatments for long-term control of CHE.In this issue of the BJD, Worm and colleagues report the promising results of a 16-week double-blind, randomized phase IIb trial in which they explore the dose response, efficacy and safety of the topical pan-Janus kinase (JAK) inhibitor delgocitinib for CHE. 5 Adults with mild-to-severe CHE were treated with delgocitinib cream 1, 3, 8 or 20 mg g À1 , or cream vehicle twice daily for 16 weeks. Delgocitinib 8 mg g À1 and 20 mg g À1 showed a statistically significant treatment effect against vehicle; treatment success was achieved in 37% and 38% of patients, respectively. The treatment effect had not reached a plateau at week 16, suggesting that more prolonged treatment could show additional benefits. Delgocitinib was well tolerated without raising any safety concerns.It is strongly recommended to patch test all patients with CHE, which was also performed prior to the study from Worm et al. 2,5 However, patch testing results were not restrictive for inclusion. Consequently, patients entering the study could have had exposure to contact allergens that were highly relevant for the severity of their HE. As the proportion of patients with a main diagnosis of allergic contact dermatitis was rather small, this possibly had limited influence on the study results.JAK inhibitors target several cytokine pathways instead of one single pathway. Therefore, delgocitinib may benefit different aetiological and clinical subtypes of CHE. The current study included several subtypes of HE, but no data were presented on the effectiveness of delgocitinib on the different subtypes. This is an important issue that needs further assessment.In this study, patients with mild-to-severe HE were included. In general, mild eczema can be treated quite well with existing topical treatments. There is a large unmet need for effective treatment in patients with moderate-to-severe CHE. The effectiveness of delgocitinib in this subgroup should be evaluated separately in future studies.As clinicians, we need an effective and safe treatment option for prolonged treatment of patients with CHE in daily practice. Therefore, new data on the long-term effectiveness and safety should be awaited to draw firm conclusions on the value of this new drug for CHE treatment. As recommended in the Cochran...

show abstract

Psychiatric disorders and suicidal behavior in patients with acne prescribed oral antibiotics versus isotretinoin: Analysis of a large commercial insurance claims database

Cited by 17 publications

References 21 publications

Isotretinoin and adverse neuropsychiatric outcomes: retrospective cohort study using routine data*

Isotretinoin and adverse neuropsychiatric outcomes: retrospective cohort study using routine data*

First use of the Adolescent Depression Rating Scale (ADRS) in the management of young people with severe acne treated with isotretinoin: a pilot study of an active monitoring of depressive disorders by dermatologists

Isotretinoin does not contribute to increased neuropsychiatric risk in the overall acne population, but risk management during treatment remains essential

Contact Info

Product

Resources

About