Association Between Isotretinoin and Adverse Neuropsychiatric Outcomes

TAKE-HOME MESSAGE

• This cohort study compared the incidence of neuropsychiatric outcomes in acne patients treated with and without isotretinoin. Patients with acne had greater odds of adverse neuropsychiatric outcomes compared with those without. In acne patients, isotretinoin exposure was associated with a lower risk of neuropsychiatric outcomes compared with acne patients without prescribed anti-acne medication (OR, 1.06), those with topical anti-acne medicines (OR, 0.94), and those on oral antibiotics (OR, 0.80).

• The study showed that isotretinoin therapy may reduce the neuropsychiatric risk associated with recalcitrant moderate to severe acne.

–  Joshua R. Ortego, MD

Abstract 

BACKGROUND

Severe neuropsychiatric outcomes have been reported in individuals exposed to isotretinoin, but the evidence is inconclusive and complicated by several methodological limitations.

OBJECTIVES

To establish and quantify the association between isotretinoin and one-year incident neuropsychiatric adverse outcomes.

METHODS

Propensity score matched cohort study of electronic medical records between years 2013 and 2019 with patients followed up for one year after their index dispensed prescription. Over 12 million patients aged 12 to 27 years from 56 healthcare organizations. Patients aged 12 to 27 years with a dispensed prescription for isotretinoin or control prescription. International Classification of Diseases Clinical Modification 10threvision diagnoses of any incident sleep or mental health disorder, or non-fatal self-harm within one year of the index prescription. Odds ratios (OR) with 95% confidence intervals (95%CI).

RESULTS

We included 30866 acne patients in the isotretinoin cohort, 44748 patients in the oral antibiotics cohort, 108367 in the topical anti-acne agents cohort, and 78666 in the cohort of acne patients without anti-acne prescription medicines. After propensity score-matching for baseline confounders, the OR for any incident neuropsychiatric outcomes in acne patients exposed to isotretinoin was 0.80 (95%CI: 0.74 to 0.87) compared to acne patients with oral antibiotics, 0.94 (95%CI: 0.87 to 1.02) compared to acne patients with topical anti-acne medicines, and 1.06 (95%CI: 0.97 to 1.16) compared to acne patients without prescription anti-acne medicines. Patients exposed to isotretinoin experienced significantly more incident physical symptoms than patients in any of the three comparison cohorts.

CONCLUSIONS

Isotretinoin was not independently associated with excess adverse neuropsychiatric outcomes at the population level. In 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 the prescribed medication on mental health.

The British Journal of Dermatology

Isotretinoin and adverse neuropsychiatric outcomes: retrospective cohort study using routine data

Br J Dermatol 2022 Feb 10;[EPub Ahead of Print], T Paljarvi, T McPherson, S Luciano, K Herttua, S Fazel 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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