Isotretinoin Laboratory Monitoring in Acne Treatment

Autor: Xia, Eric, Han, Jane, Faletsky, Adam, Baldwin, Hilary, Beleznay, Katie, Bettoli, Vincenzo, Dréno, Brigitte, Goh, Chee Leok, Stein Gold, Linda, Gollnick, Harald, Herane, Maria Isabel, Kang, Sewon, Kircik, Leon, Mann, Julianne, Nast, Alexander, Oon, Hazel, See, Jo Ann, Tollefson, Megha, Webster, Guy, Zip, Catherine, Tan, Jerry, Tapper, Elliot, Thiboutot, Diane, Zaenglein, Andrea, Barbieri, John, Mostaghimi, Arash
Přispěvatelé: Harvard Medical School [Boston] (HMS), Boston University School of Medicine (BUSM), Boston University [Boston] (BU), Stritch School of Medicine, Tufts University School of Medicine [Boston], Rutgers Robert Wood Johnson Medical School [New Brunswick, NJ, USA] (Rutgers-New Brunswick), University of British Columbia (UBC), Università degli Studi di Ferrara = University of Ferrara (UniFE), Immunology and New Concepts in ImmunoTherapy (INCIT), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), Centre hospitalier universitaire de Nantes (CHU Nantes), National Skin Center [Singapore] (NSC), Henry Ford Health System, Otto-von-Guericke-Universität Magdeburg = Otto-von-Guericke University [Magdeburg] (OVGU), Universidad de los Andes [Santiago] (UANDES), Johns Hopkins University School of Medicine [Baltimore], Icahn School of Medicine at Mount Sinai [New York] (MSSM), Inflammatory Bowel Disease Center [Dartmouth-Hitchcock Medical Center], Dartmouth Hitchcock Medical Center, Humboldt University Of Berlin, Central Sydney Dermatology [Sydney, Australia] (CSD), Mayo Clinic [Rochester], Jefferson (Philadelphia University + Thomas Jefferson University), University of Calgary, University of Western Ontario (UWO), University of Michigan Medical School [Ann Arbor], University of Michigan [Ann Arbor], University of Michigan System-University of Michigan System, Pennsylvania State University (Penn State), Penn State System, Children's Hospital of Philadelphia, University of Pennsylvania, Pecqueret, Valérie
Rok vydání: 2022
Předmět:
Zdroj: JAMA Dermatology
JAMA Dermatology, 2022, Online ahead of print. ⟨10.1001/jamadermatol.2022.2044⟩
ISSN: 2168-6068
2168-6084
DOI: 10.1001/jamadermatol.2022.2044
Popis: ImportanceAlthough isotretinoin may rarely be associated with laboratory abnormalities such as hypertriglyceridemia, the optimal approach to laboratory monitoring is uncertain, and there is wide variation in clinical practice.ObjectiveTo establish a consensus for isotretinoin laboratory monitoring among a diverse, international cohort of clinical and research experts in acne.Design, Setting, and ParticipantsUsing a modified electronic Delphi process, 4 rounds of anonymous electronic surveys were administered from 2021 to 2022. For laboratory tests reaching consensus (≥70% agreement) for inclusion, questions regarding more time-specific monitoring throughout isotretinoin therapy were asked in subsequent rounds. The participants were international board-certified dermatologist acne experts who were selected on a voluntary basis based on involvement in acne-related professional organizations and research.Main Outcomes and MeasuresThe primary outcome measured was whether participants could reach consensus on key isotretinoin laboratory monitoring parameters.ResultsThe 22 participants from 5 continents had a mean (SD) time in practice of 23.7 (11.6) years and represented a variety of practice settings. Throughout the 4-round study, participation rates ranged from 90% to 100%. Consensus was achieved for the following: check alanine aminotransferase within a month prior to initiation (89.5%) and at peak dose (89.5%) but not monthly (76.2%) or after treatment completion (73.7%); check triglycerides within a month prior to initiation (89.5%) and at peak dose (78.9%) but not monthly (84.2%) or after treatment completion (73.7%); do not check complete blood cell count or basic metabolic panel parameters at any point during isotretinoin treatment (all >70%); do not check gamma-glutamyl transferase (78.9%), bilirubin (81.0%), albumin (72.7%), total protein (72.7%), low-density lipoprotein (73.7%), high-density lipoprotein (73.7%), or C-reactive protein (77.3%).Conclusions and RelevanceThis Delphi study identified a core set of laboratory tests that should be evaluated prior to and during treatment with isotretinoin. These results provide valuable data to guide clinical practice and clinical guideline development to optimize laboratory monitoring in patients treated with isotretinoin.
Databáze: OpenAIRE
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