Patterns and utilization of isotretinoin for acne from 1984 to 2003: is there need for concern?

Abstract

Objectives: To (1) describe the patterns and trends of isotretinoin utilization between 1984 and 2003, (2) describe the characteristics of isotretinoin users within that same time period, (3) identify and quantify predictors of isotretinoin use, and (4) describe the impact of guidelines on isotretinoin utilization between 1984 and 2003.

Methods: Using the Régie de l'Assurance Maladie du Québec (healthcare utilization, medications) and Med-Echo (hospitalizations) administrative databases, we conducted a descriptive study on a population-based sample of first-time isotretinoin users from 1984 to 2003. We determined the characteristics of these users, predictors of an isotretinoin treatment >or=20 weeks, and impact of guidelines on the number of new isotretinoin users. Guidelines included the implementation of the Pregnancy Prevention Program (PPP - 1988) and the Dear Healthcare Professional Letter regarding possible psychiatric risks issued to Canadian physicians (DHPL - 2001).

Results: Mean (SD) age was 23.9 (7.6) years; 50% males, 52% welfare recipients, 77% urban dwellers, and 55% of prescriptions were written by dermatologists. Sixty-four percent of patients did not receive any anti-acne medications in the 12 months prior to receiving isotretinoin. Thirty-five percent of patients had an isotretinoin treatment >or=20 weeks suggested by product guidelines. The odds ratio of having a treatment >or=20 weeks significantly increased after the implementation of the PPP and other guidelines. There was no statistically significant decrease in the number of new isotretinoin users following the implementation of the PPP and DHPL.

Conclusion: These data suggest inappropriate isotretinoin utilization, even more so after guidelines were promulgated.