Risk of psychiatric events in women treated with isotretinoin: a self-controlled study with SIDIAP database

Vona-Giralt, Gemma; Vilaplana-Carnerero, Carles; Ouchi, Dan; Gómez-Lumbreras, Ainhoa; Morros, Rosa; Giner-Soriano, Maria

doi:10.1080/14740338.2022.2120608

Cited by 4 publications

(17 citation statements)

References 23 publications

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“…As seen in Figure 3, the 1-year absolute risk of depression was 3.83% (95% CI, 2.45-5.93; I 2 = 77%; 11 studies including 80 485 participants); of mood disorder, 2.32% (95% CI, 0.64-8.13; I 2 = 99%; 3 studies including 32 928 participants); and of bipolar disorder, 0.57% (95% CI, 0.31-1.07; I 2 = 87%; 2 studies including 79 625 participants) . The 1-year absolute risk of all psychiatric disorders was 4.57% (95% CI, 1.58-12.48; I 2 = 100%; 4 studies with 5 cohorts including 61 850 participants); of anxiety, 6.67% (95% CI, 2.77-15.19; I 2 = 100%; 4 studies including 96 196 participants); of psychotic disorders, 0.13% (95% CI, 0.08-0.23; I 2 = 77%; 3 studies including 108 698 participants); and of sleep disorders, 0.74% (95% CI, 0.27-1.98; I 2 = 99%; 5 studies including 252 763 participants) (eFigure 1 in Supplement 1).…”

Section: Resultsmentioning

confidence: 99%

“…Isotretinoin users were not at higher risk of all psychiatric disorders (RR, 1.08; 95% CI, 0.99-1.19; I 2 = 0%; 4 studies including 59 247 participants), depression (RR, 1.46; 95% CI, 0.55-3.87; I 2 = 80%; 2 studies including 73 784 participants), anxiety (RR, 0.97; 95% CI, 0.73-1.30; I 2 = 97%; 2 studies including 117 402 participants), psychotic disorders (RR, 0.80; 95% CI, 0.41-1.58; I 2 = 78%; 2 studies including 132 324 participants), and sleep disorders (RR, 1.61; 95% CI, 0.89-2.93; I 2 = 98%; 2 studies including 273 541 participants) at 1 year following treatment (eFigure 6 in Supplement 1). There were insufficient studies to perform a subgroup analysis and assess publication bias.…”

Section: Resultsmentioning

confidence: 99%

“…Further screening by full text excluded 90 articles. The review comprised 25 articles, of which 24 were included in the meta-analysis …”

Section: Resultsmentioning

confidence: 99%

“…Three studies investigated the risk factors for psychiatric disorders among isotretinoin users. Vona-Giralt et al reported that isotretinoin users with a psychiatric history were more likely to develop incident psychiatric disorders (incidence rate ratio, 1.60; 95% CI, 1.34-1.92). Droitcourt et al found that the cumulative dose of isotretinoin (in increments of 1000 mg) was associated with a lower risk of suicide attempt (OR, 0.77; 95% CI, 0.68-0.89), while patients with a psychiatric history were more likely to attempt suicide (OR, 18.21; 95% CI, 9.96-33.30) .…”

Section: Resultsmentioning

confidence: 99%

“…; of anxiety, 6.67% (95% CI, 2.77-15.19; I 2 = 100%; 4 studies including 96 196 participants)21,22, 28,45 ; of psychotic disorders, 0.13% (95% CI, 0.08-0.23; I 2 = 77%; 3 studies including 108 698Figure 1. PRISMA Flow Diagram of Study Selection…”

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confidence: 99%

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Risk of Suicide and Psychiatric Disorders Among Isotretinoin Users

Tan,

Tang,

MacAlevey

et al. 2024

JAMA Dermatol

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ImportanceIsotretinoin is hypothesized to contribute to the development of psychiatric disorders, but the epidemiological association and risk factors associated with psychiatric disorders among isotretinoin users remain unclear.ObjectiveTo clarify the absolute and relative risk and risk factors associated with suicide and psychiatric disorders among isotretinoin users.Data SourcesPubMed, Embase, Web of Science, and Scopus were searched from inception until January 24, 2023.Study SelectionRandomized trials and observational studies were selected if they reported the absolute risk, relative risk, and risk factors for suicide and psychiatric disorders among isotretinoin users.Data Extraction and SynthesisRelevant data were extracted and risk of bias was evaluated at the study level using the Newcastle-Ottawa Scale. Data were pooled using inverse variance-weighted meta-analyses. Heterogeneity was measured using the I2 statistic, and meta-regression analyses were performed.Main Outcomes and MeasuresAbsolute risk (percentage), relative risks (risk ratios [RR]), and risk factors (RR) of suicide and psychiatric disorders among isotretinoin users.ResultsA total of 25 studies including 1 625 891 participants were included in the review and 24 in the meta-analysis. Among the included studies, participants’ average age ranged from 16 to 38 years, and distribution by sex ranged from 0% to 100% male. The 1-year pooled absolute risk from between 2 and 8 studies of completed suicide, suicide attempt, suicide ideation, and self-harm were each less than 0.5%, while that of depression was 3.83% (95% CI, 2.45-5.93; I2 = 77%) in 11 studies. Isotretinoin users were less likely than nonusers to attempt suicide at 2 years (RR, 0.92; 95% CI, 0.84-1.00; I2 = 0%), 3 years (RR, 0.86; 95% CI, 0.77-0.95; I2 = 0%), and 4 years (RR, 0.85; 95% CI, 0.72-1.00; I2 = 23%) following treatment. Isotretinoin was not associated with the risk of all psychiatric disorders (RR, 1.08; 95% CI, 0.99-1.19; I2 = 0%). Study-level meta-regression found that studies with participants of older age reported lower 1-year absolute risk of depression, while those with a higher percentage of male participants reported a higher 1-year absolute risk of completed suicide.Conclusions and RelevanceThe findings suggest that at a population level, isotretinoin users do not have increased risk of suicide or psychiatric conditions but may instead have a lower risk of suicide attempts at 2 to 4 years following treatment. While these findings are reassuring, clinicians should continue to practice holistic psychodermatologic care and monitor patients for signs of mental distress during isotretinoin treatment.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Further screening by full text excluded 90 articles. The review comprised 25 articles, of which 24 were included in the meta-analysis …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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Risk of Suicide and Psychiatric Disorders Among Isotretinoin Users

Tan,

Tang,

MacAlevey

et al. 2024

JAMA Dermatol

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Acne treatment challenges – Recommendations of Latin American expert consensus

Rocha,

Barnes,

Calderón

et al. 2024

Anais Brasileiros de Dermatologia

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Clinical Care of Acne Vulgaris for Transgender and Gender Diverse Youth

Zimmer,

Hodax,

Zaenglein

et al. 2024

Pediatrics in Review

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Primary care providers have reported feeling ill-equipped to care for transgender and gender diverse (TGD) patients because of lack of training, and their treatment of acne has been shown to be variable and not standardized. This is an important practice gap, as TGD youth represent a historically underserved population in medicine, despite data suggesting that up to 9.2% of high school–age adolescents identify as TGD. Although needs and expectations for quality health-care in TGD youth do not necessarily differ from their cisgender peers, TGD adolescents have unique considerations in their care and are at risk for negative social and emotional outcomes secondary to minority stress, discrimination, and rejection by peers and family. Acne is estimated to affect approximately 85% of adolescents and is associated with negative mental health outcomes, including suicidal ideation, low self-esteem, and depression. As such, knowledgeable and culturally informed care of acne in TGD adolescents has important implications for quality of life for patients who desire effective treatment. This review article addresses these practice gaps by summarizing an approach to acne evaluation and management with an emphasis on appropriate regimens for TGD youth, and the unique psychosocial and medical considerations for this population.

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Risk of psychiatric events in women treated with isotretinoin: a self-controlled study with SIDIAP database

Cited by 4 publications

References 23 publications

Risk of Suicide and Psychiatric Disorders Among Isotretinoin Users

Risk of Suicide and Psychiatric Disorders Among Isotretinoin Users

Acne treatment challenges – Recommendations of Latin American expert consensus

Clinical Care of Acne Vulgaris for Transgender and Gender Diverse Youth

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