Monthly lab testing for all patients who are using standard doses of isotretinoin may not be necessary after all, according to an article published online by JAMA Dermatology.
Isotretinoin has been associated with several adverse effects, including teratogenicity and hyperlipidemia. Prior studies have looked at the usefulness of laboratory monitoring during isotretinoin therapy.
In the new study, researchers who were led by Joslyn S. Kirby, MD, MEd, MS, of the Penn State Milton S. Hershey Medical Center in Hershey, Pa, reviewed medical literature to estimate changes in laboratory tests during isotretinoin therapy. The authors included 26 studies of 1,574 patients in their meta-analysis, which evaluated laboratory test results for lipid levels, hepatic function, and complete blood cell counts.
Digital Extra: Dr Kirby discusses the results.
Severe Effects Are Rare
Although isotretinoin was associated with a change in the average value of some laboratory tests (white blood cell count and hepatic and lipid panels), the average change across a patient group did not meet the criteria for high-risk and the proportion of patients with laboratory abnormalities was low, the study showed.
“The findings of this study suggest that less frequent laboratory monitoring may be safe, with few missed high-risk laboratory changes, for many patents with acne who are receiving typical doses of isotretinoin. … A decrease in the frequency of laboratory monitoring for some patients could help to decrease health care spending and potential anxiety-provoking blood sampling,” the study concludes.
However, the authors note their study should be considered in the context of some limitations, which include that the analysis was limited by the availability of data and the completeness of reports. In addition, authors did not have access to information about patients or the treatment, so specific laboratory changes could not be correlated with doses or dose changes.