Are Monthly Isotretinoin Lab Tests Excessive?

It has become unnecessary for dermatologists to request monthly lab tests for patients administered standard doses of isotretinoin for the treatment of severe acne.

Although isotretinoin treatment typically lasts 4-5 months and produces permanent clearing in approximately 85% of patients, the prescription had been linked to severe adverse effects like teratogenicity (causing birth defects) and hyperlipidemia.

Typically, to be eligible for treatment with isotretinoin, patients must complete a blood test, and women of childbearing age are required to provide two negative pregnancy tests before receiving a prescription. Additionally, potential patients must commit to the iPLEDGE program — agreeing to see the dermatologist every 30 days and self-administering regular pregnancy tests.

To estimate changes in laboratory tests during isotretinoin therapy, Joslyn S. Kirby, MD, Med, MS, Penn State Milton S. Hershey Medical Center, Hershey, PA, and colleagues evaluated laboratory test results for lipid levels, hepatic function, and complete blood cell counts in 1,574 patients (26 studies).

Study results showed that although isotretinoin was associated with a change in the mean value of white blood cell count and hepatic and lipid panels, the actual average change among patient groups didn’t meet the necessary criteria for high-risk.

“The findings of this study suggest that less frequent laboratory monitoring may be safe, with few missed high-risk laboratory changes, for many patients 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,” concluded the authors.