Laboratory Monitoring Remains Common Practice for Acne

Frequent laboratory monitoring remains a common practice in the treatment of acne, but is it necessary?

Monitoring of laboratory markers in patients with acne remains a common practice and its use has not decreased substantially over time. This is according to a study published in the Journal of the American Academy of Dermatology.

A random 10% sample from the OptumInsights Electronic Health Record Database was used to obtain deidentified patient-level data from 2007 to 2017. The dataset included patients who received prescription isotretinoin for acne during this time period (n=1863; median age, 18.2 years). Only patients who had ≥6 months of continuous enrollment before the index date with no isotretinoin prescriptions and ≥1 year of continuous enrollment following the index date were included. The study investigators assessed the frequency of laboratory abnormalities, particularly for triglycerides, total cholesterol, aspartate aminotransferase, alanine aminotransferase, white blood cell count, and platelet count.

Between 2008 to 2016, there was a 16.4% decrease in the frequency of triglyceride monitoring (incidence rate ratio [IRR] per year, 0.98; 95% CI, 0.96-0.99) and a 12.5% decrease in the frequency of cholesterol monitoring (IRR per year, 0.97; 95% CI, 0.95-1.00). Likewise, there was a 20.9% decrease in the frequency of aspartate aminotransferase monitoring (IRR, 0.98 per year; 95% CI, 0.96-0.99), a 25.0% decrease in alanine aminotransferase monitoring (IRR, 0.99 per year; 95% CI, 0.97-1.00), a 12.2% decrease in the frequency of white blood cell count monitoring (IRR per year, 1.00; 95% CI, 0.97-1.02), and a 12.2% decrease in the frequency of platelet count monitoring (IRR, 0.99 per year; 95% CI, 0.97-1.02) during this time period.

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Fewer than 1% of patients screened between 2008 and 2017 demonstrated grade 3 triglyceride abnormalities. More than half (58.3%) of patients in whom grade 3 triglyceride abnormalities had developed while on therapy also had elevated triglyceride levels at baseline. Approximately 0.5% of patients screened had liver function testing abnormalities. The researchers found no greater than or equal to  grade 3 cholesterol or complete blood count abnormalities or clinically meaningful changes in the frequency of laboratory monitoring.

Limitations of the study include the retrospective analysis of electronic medical records as well as the lack of assessment on isotretinoin doses across patients.

“There are opportunities to improve the quality and cost of care by reducing the frequency of lipid and liver function monitoring and by eliminating the practice of complete blood count monitoring in this patient population,” the investigators wrote, “which should be highlighted in future clinical guidelines.”

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Barbieri JS, Shin DB, Wang S, Margolis DJ, Takeshita J. The clinical utility of laboratory monitoring during isotretinoin therapy for acne and changes to monitoring practices over time [published online June 19, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.06.025