Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
J Am Acad Dermatol. 2020 Jan;82(1):72-79. doi: 10.1016/j.jaad.2019.06.025. Epub 2019 Jun 19.
As a result of concerns about hypertriglyceridemia, liver enzyme abnormalities, and leukopenia during isotretinoin therapy for acne, patients are often monitored closely with routine laboratory assessments, although the value of this practice has been questioned.
We conducted a cohort study of patients receiving isotretinoin for acne between January 1, 2008, and June 30, 2017, using the OptumInsights Electronic Health Record Database (Optum, Eden Prairie, MN) to evaluate the frequency of laboratory abnormalities. Poisson regression was used to evaluate for changes to the frequency of routine laboratory monitoring over time.
Among 1863 patients treated with isotretinoin, grade 3 or greater triglyceride and liver function testing abnormalities were noted in fewer than 1% and 0.5% of patients screened, respectively. No grade 3 or greater cholesterol or complete blood count abnormalities were observed. There were no meaningful changes in the frequency of laboratory monitoring over time.
Limitations include that we are unable to evaluate the clinical notes to understand the exact clinical decision making when clinicians encountered abnormal laboratory values.
Although laboratory abnormalities are rare and often do not influence management, frequent laboratory monitoring remains a common practice. There are opportunities to improve the quality of care among patients being treated with isotretinoin for acne by reducing the frequency of lipid and liver function monitoring and by eliminating complete blood count monitoring.
由于担心异维 A 酸治疗痤疮时会出现高甘油三酯血症、肝酶异常和白细胞减少症，患者通常会接受常规实验室评估的密切监测，尽管这种做法的价值一直受到质疑。
我们使用 OptumInsights 电子健康记录数据库（Optum，明尼苏达州 Eden Prairie）进行了一项 2008 年 1 月 1 日至 2017 年 6 月 30 日期间接受异维 A 酸治疗痤疮的患者队列研究，以评估实验室异常的频率。使用泊松回归评估随时间变化常规实验室监测的频率变化。
在 1863 名接受异维 A 酸治疗的患者中，分别有不到 1%和 0.5%的患者筛查出 3 级或更高级别的甘油三酯和肝功能检查异常。未观察到 3 级或更高级别的胆固醇或全血细胞计数异常。随着时间的推移，实验室监测的频率没有明显变化。
限制包括我们无法评估临床记录，以了解临床医生遇到异常实验室值时的确切临床决策。
尽管实验室异常很少见，且通常不会影响治疗，但频繁的实验室监测仍然是常见的做法。通过减少血脂和肝功能监测的频率，并消除全血细胞计数监测，可以为接受异维 A 酸治疗痤疮的患者提供更好的护理质量。
