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Monthly lab testing not supported for isotretinoin treatment for acne

Results of a systematic review and meta-analysis found that monthly laboratory testing was not supported for patients receiving standard doses of oral isotretinoin for the treatment of acne.

Researchers searched Ovid/Medline, Embase and gray literature from 1960 to Aug. 1, 2013, to identify relevant studies of isotretinoin use in acne vulgaris. Search terms related to acne treatment, isotretinoin and diagnostic procedures were included.

Clinical trials using oral isotretinoin, doses of 40 mg a day or more for a duration of at least 4 weeks in adolescents and adults aged 9 to 34 years with acne vulgaris and 10 or more participants were inclusion requirements for the clinical trials.

Full-text examination was conducted for 116 studies, with data from 61 of the studies evaluated. The meta-analysis included 26 studies (1,574 patients): 22 randomized clinical trials and four retrospective studies.

For the lipid panel, mean values of nonbaseline measurements were: triglycerides, 119.98 mg/dL (99% CI, 98.58-141.39); total cholesterol, 184.74 mg/dL (95% CI, 178.17-191.31);  low-density lipoprotein cholesterol, 109.23 mg/dL (99% CI, 103.68-114.79); and high-density lipoprotein cholesterol, 42.89 mg/dL (99% CI, 39.84-45.76). Mean values for the hepatic panel included: aspartate aminotransferase, 22.67 U/L (99% CI, 19.94-25.41); alanine aminotransferase, 21.77 U/L (99% CI, 18.96-24.59); and alkaline phosphatase, 88.35 U/L (99% CI, 58.94-117.76). The mean white blood cell count was 6890/µL (99% CI, 5700-8030).

“This meta-analysis showed that isotretinoin is associated with a statistically significant change in the mean value of several laboratory tests, yet the mean changes across a patient group did not meet a priori criteria for high-risk and the proportion of patients with laboratory abnormalities was low,” the researchers wrote.

“The results of this study do not support the use of monthly laboratory tests for all patients with acne who receive standard doses of isotretinoin,” the researchers concluded. “A decrease in the frequency of laboratory monitoring for some patients could help to decrease the health care spending and potential anxiety-provoking blood sampling. Further studies may be needed to investigate the influence of patient characteristics, which may allow risk stratification and, subsequently, clinically indicated and cost-efficient monitoring.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.