Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, OX3 7JX, UK.
Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland.
Br J Dermatol. 2022 Jul;187(1):64-72. doi: 10.1111/bjd.21049. Epub 2022 Apr 12.
Severe neuropsychiatric outcomes have been reported in individuals exposed to isotretinoin, but the evidence is inconclusive and complicated by several methodological limitations.
To establish and quantify the association between isotretinoin use for acne and 1-year incident neuropsychiatric adverse outcomes.
A propensity score-matched cohort study of electronic medical records between the years 2013 and 2019 with patients followed up for 1 year after their index dispensed prescription was conducted. The database included over 12 million patients aged 12-27 years. We analysed data for individuals with acne in this age range with a dispensed prescription for isotretinoin or a control prescription. Outcomes included diagnoses of any incident sleep or mental health disorder, or nonfatal self-harm within 1 year of the index prescription.
We included 30 866 patients prescribed isotretinoin for their acne, 44 748 prescribed oral antibiotics, 108 367 prescribed topical anti-acne agents and 78 666 patients with acne but without an anti-acne prescription. After propensity score matching for baseline confounders, the odds ratio (OR) for any incident neuropsychiatric outcomes in patients with acne exposed to isotretinoin was 0·80 [95% confidence interval (CI) 0·74-0·87] compared with those on oral antibiotics; 0·94 (95% CI 0·87-1·02) compared with those using topical anti-acne medicines; and 1·06 (95% CI 0·97-1·16) compared with those without a prescription for anti-acne medicines. Patients exposed to isotretinoin experienced significantly more incident physical symptoms than patients in any of the three comparison cohorts.
Isotretinoin was not independently associated with excess adverse neuropsychiatric outcomes at the population level. When monitoring potential adverse outcomes during isotretinoin treatment, clinicians should also consider the high mental health burden associated with treatment-resistant acne and the potential contribution of physical side-effects of prescribed medication on mental health.
据报道，接触异维 A 酸的个体出现严重神经精神不良结局，但证据尚不明确，且存在多种方法学局限性。
确定并量化异维 A 酸治疗痤疮与 1 年新发神经精神不良结局之间的关联。
对 2013 年至 2019 年的电子病历进行倾向评分匹配队列研究，对索引配药后 1 年的患者进行随访。该数据库包含超过 1200 万 12-27 岁的患者。我们分析了该年龄范围内患有痤疮、并接受异维 A 酸处方或对照处方治疗的患者的数据。结局包括索引处方后 1 年内任何新发睡眠或精神健康障碍或非致命性自伤的诊断。
我们纳入了 30866 例因痤疮而接受异维 A 酸治疗的患者、44748 例接受口服抗生素治疗的患者、108367 例接受局部抗痤疮药物治疗的患者和 78666 例有痤疮但未开抗痤疮药物的患者。在对基线混杂因素进行倾向评分匹配后，与接受口服抗生素治疗的患者相比，痤疮患者接受异维 A 酸治疗后新发神经精神不良结局的比值比（OR）为 0.80（95%CI 0.74-0.87）；与使用局部抗痤疮药物的患者相比为 0.94（95%CI 0.87-1.02）；与未开具抗痤疮药物处方的患者相比为 1.06（95%CI 0.97-1.16）。与任何比较队列的患者相比，接受异维 A 酸治疗的患者出现新发躯体症状的比例显著更高。
在人群水平，异维 A 酸与不良神经精神结局无关。在监测异维 A 酸治疗期间潜在的不良结局时，临床医生还应考虑治疗抵抗性痤疮相关的高心理健康负担以及处方药物的躯体副作用对心理健康的潜在影响。
