Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Boston University School of Medicine, Boston, Massachusetts.
JAMA Dermatol. 2022 Aug 1;158(8):942-948. doi: 10.1001/jamadermatol.2022.2044.
Although 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.
To establish a consensus for isotretinoin laboratory monitoring among a diverse, international cohort of clinical and research experts in acne.
DESIGN, SETTING, AND PARTICIPANTS: Using 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.
The primary outcome measured was whether participants could reach consensus on key isotretinoin laboratory monitoring parameters.
The 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%).
This 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.
尽管异维 A 酸可能很少与实验室异常有关，如高甘油三酯血症，但最佳的实验室监测方法尚不确定，临床实践存在广泛差异。
在一组来自不同国家的痤疮临床和研究专家中，就异维 A 酸的实验室监测达成共识。
设计、设置和参与者：使用改良的电子德尔菲法，从 2021 年到 2022 年，进行了四轮匿名电子调查。对于达到共识（≥70%的一致性）的实验室检测，在随后的轮次中会询问关于异维 A 酸治疗过程中更具体时间的监测问题。参与者为国际认证的皮肤科痤疮专家，他们是根据参与痤疮相关专业组织和研究的情况自愿选择的。
主要测量指标是参与者是否能够就关键的异维 A 酸实验室监测参数达成共识。
来自 5 大洲的 22 名参与者平均（SD）从业时间为 23.7（11.6）年，代表了各种实践环境。在整个 4 轮研究中，参与率从 90%到 100%不等。达成共识的参数如下：在开始前一个月（89.5%）和峰值剂量时（89.5%）检查丙氨酸氨基转移酶，但不每月（76.2%）或治疗完成后（73.7%）检查；在开始前一个月（89.5%）和峰值剂量时（78.9%）检查甘油三酯，但不每月（84.2%）或治疗完成后（73.7%）检查；在异维 A 酸治疗期间的任何时候都不检查全血细胞计数或基本代谢面板参数（均＞70%）；不检查γ-谷氨酰转移酶（78.9%）、胆红素（81.0%）、白蛋白（72.7%）、总蛋白（72.7%）、低密度脂蛋白（73.7%）、高密度脂蛋白（73.7%）或 C 反应蛋白（77.3%）。
这项德尔菲研究确定了一组在开始治疗和治疗期间应评估的实验室检测。这些结果为指导临床实践和临床指南的制定提供了有价值的数据，以优化接受异维 A 酸治疗的患者的实验室监测。
