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

  • Pharmacoepidemiological and Prescription
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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-Écho (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 ≥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 ≥20 weeks suggested by product guidelines. The odds ratio of having a treatment ≥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.

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Acknowledgements

This study was supported by the Canadian Institutes of Health Research (CIHR grant number: IHD - 67337). Laurent Azoulay is the recipient of a doctoral bursary from the Fonds de la recherche en santé du Québec (FRSQ). Dr. Anick Bérard is the recipient of a career award from the CIHR/Canadian Foundation for Health, and is on the endowment research Chair of the Famille Louis-Boivin on ‘Medications, Pregnancy and Lactation’ at the Faculty of Pharmacy of the University of Montreal.

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Authors and Affiliations

  1. Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada

    Laurent Azoulay & Anick Bérard

  2. Sainte-Justine Hospital Research Center, 3175, chemin de la Côte-Ste-Catherine, Montreal, Quebec, H3T 1C5, Canada

    Laurent Azoulay, Driss Oraichi & Anick Bérard

Authors
  1. Laurent Azoulay
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  2. Driss Oraichi
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  3. Anick Bérard
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Correspondence to Anick Bérard.

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Azoulay, L., Oraichi, D. & Bérard, A. Patterns and utilization of isotretinoin for acne from 1984 to 2003: is there need for concern?. Eur J Clin Pharmacol 62, 667–674 (2006). https://doi.org/10.1007/s00228-006-0151-x

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  • DOI: https://doi.org/10.1007/s00228-006-0151-x

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