Labs para Roa en mayores de 35
Routine Isotretinoin Laboratory Monitoring in Patients Older Than 35 Years
TAKE-HOME MESSAGE
- In this retrospective review, the rates of laboratory abnormalities in 67 patients on isotretinoin who were older than the age of 35 years were analyzed. Total cholesterol, triglycerides, ALT, WBC, and platelet count were assessed at baseline and then monthly. During treatment, 10.5% of patients had abnormal cholesterol versus 14.7% of patients <35 years (P = .34); 29% had abnormal triglycerides versus 17.4% of patients <35 years (P = .48). Overall, 26.9% of patients ≥35 years had a grade 1 laboratory abnormality during their course of treatment versus 33.5% of patients <35 years (P = .28). Compared with 15 interruptions and 6 terminations of treatment due to laboratory abnormalities in patients <35 years, none of the patients ≥35 years had treatment interruptions or terminations.
- Recent meta-analyses have demonstrated that monthly laboratory monitoring for patients on standard doses of isotretinoin may not be necessary, but these studies did not evaluate patients over the age of 35 years. This study suggests that the rates of laboratory abnormalities are not different between these two demographic groups and the results of the prior meta-analyses can be extended to patients over the age of 35 years.
– Margaret Hammond, MD
- Written by
- Written by
- Written by
This is just the kind of article we love at PracticeUpdate: Dermatology! It provides information that leads to change in our clinical practices with a focus on improvement in patient care and cost reduction. The take-home message tells it all. The bottom line: very little is gained with monthly lab testing of older (>35 years) patients other than providing the clinician some peace of mind. Of course, monthly pregnancy testing (urine testing or serologic testing) is required as part of the I-Pledge system. These data should help with that, allowing for the fact that 60+ patients were included in the study.
Personally, we believe it makes sense to get baseline labs (complete metabolic panel, CBC, and triglycerides) so you know where you're starting. If there are no significant abnormalities, and, again, pregnancy testing has been addressed appropriately, monthly lab testing really doesn't make sense. There have been several papers we featured on the same topic of reducing laboratory monitoring in isotretinoin-treated patients of all ages. Of course, if there are elevated triglycerides before treatment is initiated, close monitoring is required along with low-fat diet and exercise. If there are liver function elevations, you may want to find a different treatment or monitor more closely (in addition, a hepatitis virus screen may be warranted). If anemia is present at baseline, you'd want to know about that. It probably also makes sense to get labs at the end of treatment from the perspective of malpractice risk, but we think one can argue that that may be overkill as well.
One of the nice COVID-19 pandemic adaptations in the past 2 months is that patients are now allowed to send a photograph of their home pregnancy test results (we've asked that patients take that picture with their face visible). It's private and convenient. With respect to pregnancy risk, patient comprehension of the risks and trust are the core of managing this issue. This is a logical extension of the trust we place in our patients.
A Retrospective Evaluation of Routine Isotretinoin Laboratory Monitoring in Patients Above 35 Years Old
J Am Acad Dermatol 2020 Apr 25;[EPub Ahead of Print], P Sharma, E Tkachenko, A MostaghimiSkin Care Physicians of Costa Rica
Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574
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posted by dermatica at
May 06, 2020
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