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Cited by 17Acne and Rosacea Treatments and EffectsPharmacovigilance and Adverse Drug ReactionsDrug-Induced Hepatotoxicity and Protection

Is routine laboratory testing in healthy young patients taking isotretinoin necessary: a critically appraised topic

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Affleck, Andrew, Jackson, David, Williams, Hywel C., Chavez, Patricia, Albrecht, Joerg·2022·British Journal of Dermatology
DOI 10.1111/bjd.21840
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Abstract

Summary: Clinical question: Is monitoring of liver function, lipids and full blood count necessary in healthy people taking isotretinoin? Background: Routine blood testing was recommended in the original licence for Roaccutane™ (isotretinoin) in 1983. In recent years, less frequent monitoring has been suggested by various authors. Data sources: We performed four individual systematic searches of the MEDLINE database, via PubMed, from origin to 2 May 2021, supplemented by a hand search of all references in the identified papers. Study selection: Inclusion criteria were any description of clinical symptoms, laboratory abnormalities and/or physical findings, and any paper that explicitly described the patients as asymptomatic, during treatment with oral isotretinoin. Data extraction: Two independent reviewers (J.A. and D.J.) assessed articles for eligibility of inclusion. Evaluation of the data was done also by two of the authors (A.A., D.J. and J.A.) for each section, with the aim to use the presented evidence including guidelines, databases, case series, case reports, cohort studies and randomized clinical trials to delineate the clinical presentation and frequency of adverse events that might be amenable to laboratory monitoring. Results: We identified 407 papers in our searches and reviewed 125 papers in four sections. Overall, reported adverse events were very rare (< 1 in 10 000) and were either idiosyncratic or not preventable by monitoring, accompanied by symptoms, or seen in identifiable predisposed individuals who might benefit from monitoring because of pre-existing conditions. Recommendation for clinical care: We could not find evidence to support the benefit of monitoring to detect adverse events. We suggest that in healthy young people laboratory monitoring for oral isotretinoin is unnecessary and risks detecting nonserious biochemical abnormalities. However, we recognize that new information about adverse events may change that recommendation.

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  • Data on laboratory monitoring in isotretinoin-treated patients have been critically appraised, with little evidence supporting the benefit of laboratory monitoring to detect adverse events.

    “Data on laboratory monitoring in patients treated with isotretinoin have been critically appraised, with little evidence to support the benefit of laboratory monitoring to detect adverse events.”

    From Guidelines of care for the management of acne vulgaris (2024) · cites this paper as [274]

    The Discussion and clinical message (page unavailable) says the review found no blood test that seemed reasonable to perform routinely in healthy young patients, supporting the claim’s account of its appraisal. The citing sentence broadens that conclusion to isotretinoin-treated patients generally; the paper says testing may benefit some patients with specific risk factors. (LLM, conf=0.86)

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2 of the 86 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

  1. [6]6. Opel D, Kramer ON, Chevalier M et al. Not every patient needs a triglyceride check, but all can get pancreatitis: a systematic review and clinical characterization of isotretinoin-associated pancreatitis. Br J Dermatol 2017; 177: 960-6.
  2. [17]17. Guzman Rojas P, Gallegos Lopez R, Ciliotta Chehade A et al. [Autoimmune hepatitis induced by isotretionine]. Rev Gastroenterol Peru 2016; 36: 86-9.
  3. [32]32. Bataille J. MM, Carlier P., Eftekhari P. Acute pancreatitis reported with isotretinoin: Study in the French pharmacovigilance database. Fundamental and Clinical Pharmacology 2014; 28: 50.
  4. [87]87. Guttman-Yassky E, Hayek T, Muchnik L et al. Acute rhabdomyolysis and myoglobinuria associated with isotretinoin treatment. Int J Dermatol 2003; 42: 499-500.

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Authors
Affleck, A., Jackson, D., Williams, H. C., Chavez, P., & Albrecht, J.
Affiliations
  • Ninewells Hospital (GB)
  • Walsall Healthcare NHS Trust (GB)
  • Rush University Medical Center (US)
  • Centre for Evidence Based Medicine Nottingham UK
Corresponding author
Albrecht, Joerg
ORCID
Venue
British Journal of Dermatology
Publisher
Oxford University Press (OUP)
Published
2022-12-01
Volume
187
Issue
6
Pages
857-865
ISSN
  • 0007-0963 (ISSN-L)
  • 1365-2133
DOI
10.1111/bjd.21840
OpenAlex
W4292549303
Semantic Scholar
31b5fc84e501b6505d70b5dbd4ecdd31ed066267
Cited by
17
References
86
Citations by year
2026: 2 · 2025: 3 · 2024: 6 · 2023: 6
FWCI
3.66
Type
journal article
Language
en
Open access
Licence
Locations
  • British Journal of Dermatology (publishedVersion)
  • PubMed (publishedVersion)
  • Discovery Research Portal (University of Dundee) (publishedVersion, other-oa)
  • Repository@Nottingham (University of Nottingham) (acceptedVersion, other-oa)
  • Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Dermatology › Acne and Rosacea Treatments and Effects
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Drug-Induced Hepatotoxicity and Protection
Keywords
isotretinoin, laboratory monitoring, liver function tests, lipid monitoring, complete blood count, adverse drug reactions, acne treatment, drug safety
MeSH terms
Adolescent, Humans, Cohort Studies, Isotretinoin

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