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Isotretinoin and neuropsychiatric side effects: Continued vigilance is needed. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021; 6. [PMID: 37168254 PMCID: PMC10168661 DOI: 10.1016/j.jadr.2021.100230] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Isotretinoin (13-cis-retinoic acid, marketed under the names Accutane, Roaccutane, and others) is an effective treatment for acne that has been on the market for over 30 years, although reports of neuropsychiatric side effects continue to be reported. Isotretinoin is an isomer of the active form of Vitamin A, 13-trans-retinoic acid, which has known psychiatric side effects when given in excessive doses, and is part of the family of compounds called retinoids, which have multiple functions in the central nervous system. Methods The literature was reviewed in pubmed and psychinfo for research related to isotretinoin and neuropsychiatric side effects including depression, suicidal thoughts, suicide, mania, anxiety, impulsivity, emotional lability, violence, aggression, and psychosis. Results Multiple case series have shown that successful treatment of acne with isotretinoin results in improvements in measures of quality of life and self esteem However, studies show individual cases of clinically significant depression and other neuropsychiatric events that, although not common, are persistent in the literature. Since the original cases of depression were reported to the United States Food and Drug Administration, numerous cases have been reported to regulatory agencies in the United Kingdom, France, Ireland, Denmark, Australia, Canada, and other countries, making isotretinoin one of the top five medications in the world associated with depression and other neuropsychiatric side effects. Clinicians are advised to warn patients of the risks of neuropsychiatric side effects with isotretinoin which may arise from the medication itself, and not just as a side effect of acne or youth.
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Poizeau F, Balusson F, Jonville-Béra AP, Nowak E, Drici MD, Scarabin PY, Droitcourt C, Dupuy A, Oger E. The cardiovascular safety of oral alitretinoin: a population-based cohort study involving 19 513 patients exposed to oral alitretinoin. Br J Dermatol 2021; 185:764-771. [PMID: 33735442 DOI: 10.1111/bjd.20069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Oral alitretinoin is a retinoid used for severe chronic hand eczema. Although caution is recommended for patients with uncontrolled dyslipidaemia or cardiovascular risk factors, the actual atherothrombotic risk has not been investigated thus far. OBJECTIVES To detect any excess of atherothrombotic events among patients exposed to alitretinoin, during treatment or in the 2 years following initiation. METHODS Using the French Health Insurance database, we compared the number of patients who had an atherothrombotic event (coronary artery disease, ischaemic stroke or peripheral artery disease requiring revascularization) in the population exposed to oral alitretinoin vs. the general population of the same age, sex and baseline cardiovascular risk, using standardized morbidity ratios (SMRs). RESULTS Between 2009 and 2017, 19 513 patients were exposed to oral alitretinoin in France. Sixty-four (0·3%) patients had an atherothrombotic event while on alitretinoin. Patients receiving alitretinoin experienced no more atherothrombotic events than the general population: patients without cardiovascular risk factors or previous atherothrombotic events had a SMR of 0·65 [95% confidence interval (CI) 0·26-1·34] during alitretinoin treatment, and 1·21 (95% CI 0·90-1·59) in the 2 years following initiation; patients with cardiovascular risk factors or previous atherothrombotic events had a SMR of 0·82 (95% CI 0·60-1·08) during alitretinoin treatment and 0·95 (95% CI 0·82-1·09) in the 2 years following initiation. Taken separately, SMRs for each outcome did not increase either. CONCLUSIONS These data from an exhaustive nationwide population-based study do not support an increase in the incidence of atherothrombotic events with alitretinoin use, regardless of the baseline cardiovascular risk of the patient.
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Affiliation(s)
- F Poizeau
- Univ Rennes, CHU Rennes, EA 7449 (Pharmacoepidemiology and Health Services Research) REPERES, Rennes, F 35043, France.,PEPS Research Consortium (Pharmacoepidemiology for Health Product Safety), Rennes, France.,Department of Dermatology, CHU Rennes, Rennes, France
| | - F Balusson
- Univ Rennes, CHU Rennes, EA 7449 (Pharmacoepidemiology and Health Services Research) REPERES, Rennes, F 35043, France
| | - A P Jonville-Béra
- Centre Régional de Pharmacovigilance, CHRU Tours, Tours, France.,Université de Tours, Université de Nantes, INSERM - U 1246, France
| | - E Nowak
- PEPS Research Consortium (Pharmacoepidemiology for Health Product Safety), Rennes, France.,University of Bretagne Occidentale, Brest University, Brest, France.,INSERM CIC 1412, CHRU Brest, Brest, France
| | - M D Drici
- Department of Clinical Pharmacology, University of Cote d'Azur Medical Center, Nice, France
| | - P Y Scarabin
- Centre de Recherche en Épidémiologie et Santé des Populations, INSERM UMRS1018, Paris-Saclay University, Villejuif, France
| | - C Droitcourt
- Univ Rennes, CHU Rennes, EA 7449 (Pharmacoepidemiology and Health Services Research) REPERES, Rennes, F 35043, France.,PEPS Research Consortium (Pharmacoepidemiology for Health Product Safety), Rennes, France.,Department of Dermatology, CHU Rennes, Rennes, France
| | - A Dupuy
- Univ Rennes, CHU Rennes, EA 7449 (Pharmacoepidemiology and Health Services Research) REPERES, Rennes, F 35043, France.,PEPS Research Consortium (Pharmacoepidemiology for Health Product Safety), Rennes, France.,Department of Dermatology, CHU Rennes, Rennes, France
| | - E Oger
- Univ Rennes, CHU Rennes, EA 7449 (Pharmacoepidemiology and Health Services Research) REPERES, Rennes, F 35043, France.,PEPS Research Consortium (Pharmacoepidemiology for Health Product Safety), Rennes, France
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Abou Taam M, Jacquot B, Ferard C, Thery AC, Mounier C, Grandvuillemin A, Jonville-Béra AP, Perault-Pochat MC. The French pharmacovigilance surveys: A French distinctiveness, a real input. Therapie 2020; 76:441-447. [DOI: 10.1016/j.therap.2020.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/29/2020] [Accepted: 05/19/2020] [Indexed: 11/17/2022]
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