Citation

Droitcourt C, Poizeau F, Kerbrat S, Balusson F, Drezen E, Happe A, Travers D, Oger E, Dupuy A. J. Eur. Acad. Dermatol. Venereol. 2019; ePub(ePub): ePub.

Affiliation

Pharmacovigilance, Pharmacoepidemiology and Drug Information Departments, PEPS Research Consortium, F35000, Rennes, France.

Copyright

(Copyright © 2019, John Wiley and Sons)

DOI

10.1111/jdv.16005

PMID

31587374

Abstract

BACKGROUND: Although the causal role of isotretinoin in suicidal behaviour is controversial, suicide attempts (SA) do occur among patients taking isotretinoin.

OBJECTIVES: To describe patient profiles and the management of isotretinoin among patients who committed or attempted suicide under treatment. To assess the risk factors for SA under isotretinoin.

METHODS: We performed a comprehensive case series of suicides and SAs under isotretinoin, and a case-control study, using Nationwide French Health Insurance database. The main analysis compared cases (subjects with a SA during a course of isotretinoin) to controls, individually matched for age, gender and rank of the current course; controls were to be exposed to isotretinoin at the index date (date of SA for the corresponding cases). The patients' psychiatric history at isotretinoin initiation was studied. In a secondary analysis, patients who continued their isotretinoin treatment after their SA were compared to patients who discontinued it.

RESULTS: In all, 328 018 subjects started a course of isotretinoin between January 1, 2010 and December 31, 2014 and 184 patients were hospitalised for a SA; half of them had a psychiatric history at initiation. In the multivariate analysis, psychiatric history and history of anxiety alone were risk factors for SA (OR, 18.21; CI95%, 9.96-33.30 and 4.78; CI95%, 2.44-9.33 respectively). Among 176 cases of SA with sufficient follow-up, 103 (58.5%) carried on with their treatment after their SA. Treatment initiation by a dermatologist was inversely associated with the continuation of the treatment after a SA (OR, 0.38; CI95%, 0.18-0.80).

CONCLUSIONS: SAs under isotretinoin are rare events and our results suggest that most of the patients concerned have a risk-prone profile detectable at the time of treatment initiation. The risk-benefit ratio of continuing isotretinoin after a SA warrants further careful evaluation.

© 2019 European Academy of Dermatology and Venereology.

Language: en