TY  - JOUR
PY  - 2019//
TI  - Isotretinoin and risk factors for suicide attempt: a population-based comprehensive case series and nested case-control study using 2010-2014 French Health Insurance Data
JO  - Journal of the European Academy of Dermatology and Venereology
A1  - Droitcourt, Catherine
A1  - Poizeau, Florence
A1  - Kerbrat, Sandrine
A1  - Balusson, Frédéric
A1  - Drezen, Erwan
A1  - Happe, André
A1  - Travers, David
A1  - Oger, Emmanuel
A1  - Dupuy, Alain
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - BACKGROUND: Although the causal role of isotretinoin in suicidal behaviour is controversial, suicide attempts (SA) do occur among patients taking isotretinoin. <br><br>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. <br><br>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. <br><br>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). <br><br>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.<br><br>© 2019 European Academy of Dermatology and Venereology.<p />  <p>Language: en</p>
LA  - en
SN  - 0926-9959
UR  - http://dx.doi.org/10.1111/jdv.16005
ID  - ref1
ER  -