Potassium monitoring remains common in women treated for acne with spironolactone

Despite recommendations contraindicating potassium level monitoring in healthy women treated for acne with spironolactone, the practice remains common among both dermatologists and internists, according to a study.

In the retrospective cohort study, John S. Barbieri, MD, MBA, of the department of dermatology at the University of Pennsylvania, and colleagues aimed to assess trends in how young women being treated for acne with spironolactone are monitored for potassium levels. The researchers also aimed to determine whether there was variability from clinician to clinician in potassium monitoring habits.

Data for 108,547 healthy female patients aged 12 to 45 years from the Optum deidentified Clinformatics Data Mart database underwent analysis. Patients treated between Jan. 1, 2008, and June 30, 2019, were eligible.

The proportion of patients who received a baseline potassium level test along with the proportion of those who underwent potassium level monitoring within 180 days of spironolactone treatment initiation served as the primary outcome measures.

Regarding the clinician-based endpoints, the researchers also looked at those who had prescribed at least five courses of the study drug to determine the percentage of doctors who ordered baseline testing or monitoring and the percentage who always monitored potassium levels. These percentages were compared for two time periods: between 2008 and 2015 and between 2016 and 2018.

Eligible participants had a mean age of 30.7 years and underwent spironolactone treatment for a mean course duration of 159 days.

In 2008, 41.4% of women treated by any clinician had their potassium levels monitored within 180 days of treatment initiation. That proportion decreased to 38.5% by 2018.

Looking specifically at dermatologists, 48.9% of women underwent monitoring within 180 days in 2008, while just 41% were monitored by 2018.

For women treated by internists, potassium monitoring within 180 days of spironolactone initiation decreased from 39.7% in 2008 to 37.7% in 2018.

However, among women treated by advanced practice clinicians, such as nurse practitioners or physician assistants, monitoring within 180 days increased from 71.4% to 75.4%.

Between 2008 and 2015, 10.6% of dermatologists always monitored for potassium levels in women treated with spironolactone. However, between 2016 and 2018, just 4.2% always monitored these women. Among internists, 15.8% always monitored these levels between 2008 and 2015 compared with 17.7% who monitored potassium between 2016 and 2018, which the researchers reported was not significantly different.

“Despite increasing evidence and guidelines supporting the elimination of potassium monitoring among healthy young women treated for acne with spironolactone, the present study findings suggest that potassium monitoring remains common, with substantial variability in clinician practices,” the researchers wrote. “There is a need for future implementation and dissemination research to understand underlying factors for this variation and to develop strategies to address this practice gap.”