Acne meds linked to higher cholesterol

By CHRISTINE DELL’AMORE
UPI Consumer Health Correspondent

In an observational study, researchers found people who take a particular acne medication had higher cholesterol levels than previously thought, although doctors point out the side effects are easily reversible.

Teenagers and adults who took the medication isoretinoin, marketed as Acutane, had elevations in total cholesterol; triglycerides, or blood fats, which lead to cardiovascular disease; and increases in liver enzymes, which can create liver problems.

“Isoretinoin is undeniably the most effective medication we have for treating severe acne, and it can truly be a life-changing medication for people whose acne affects them greatly,” said lead author Dr. Lee T. Zane, an assistant professor of clinical dermatology at the University of California, San Francisco.

“It’s not a cause for concern until we work out the clinical outcomes.”
The study, published in the August issue of the Archives of Dermatology, a JAMA/Archives journal, is the largest population-based study to date to look at laboratory abnormalities in patients on isotretinoin therapy.

Past studies have shown patients on isoretinoin have elevated triglycerides and liver enzymes, but at lower incidence rates. Other side effects such as pancreatitis and leukopenia, a decrease in circulating white blood cells in the bloodstream, have been reported.

Because the study was not an experiment, it does not prove whether isoretinoin actually caused these side effects, or if it was something else that accounted for the results.

The team wanted to observe how a large number of isoretinoin patients are managed in a typical way by practitioners on the job. They did not focus on how these results could be translated into actual health problems, such as cardiovascular disease.

Zane and colleagues studied records of 13,772 men and women aged 13 to 50 — average age 19 — who were taking oral isotretinoin between 1995 and 2002. The researchers did not record their ethnicity.

The team analyzed laboratory tests taken from the patients before, during and after their treatment with isoretinoin. They measured the amount of trigyclerides, total cholesterol, liver transaminase levels and other blood indicators.

The amount of abnormalities in hermatoligic parameters, which could be precursors of blood disease, did not change over the course of the study.

Zane found the patients taking the acne treatment had substantial abnormalities over time in their cholesterol and liver readings.

Of the total group, 10,656 had normal triglycerides at the start of the study, versus 6,035 with normal readings while on treatment. Likewise, 9,154 of the participants had normal total cholesterol readings at the study’s start; 5,729 had normal readings during treatment.

Overall, 44 percent of the isoretinoin patients had high trigyclerides, 31 percent had high total cholesterol and 11 percent had elevated liver values.

The package insert for Acutane, manufactured by Roche, indicates that approximately 25 percent of users experience higher triglyceride levels, and 15 percent have higher liver enzymes.

Scientists aren’t exactly sure why isoretinoin is linked to higher cholesterol and liver enzymes, Zane said.

As the gold standard for acne treatment, isoretinoin’s long-term acne remission rates are as high as 89 percent, the authors wrote. That’s why “we have to keep the safety issue in perspective, and balance it against the benefits,” Zane said.

As a precaution, most doctors now recommend their patients to undergo frequent laboratory testing while on isoretinoin treatment.

Dr. Stephen Stone, president of the American Academy of Dermatology, said the “overwhelming majority” of dermatologists follow their patients’ laboratory results closely. Side effects reported by Zane and colleagues have been known about and monitored for years, and “doesn’t really represent a danger to the patient,” Stone said.
“What this study tells us is it might be more common than we thought,” he said.
The cholesterol effects, at least, are quickly reversible, either by lowering the dosage of the medication, modifying diet, or in some cases recommending the patient take a cholesterol-lowering statin.

A past study suggested elevated triglycerides of teens on isoretinoin may uncover a genetic predisposition to high cholesterol in later years. Physicians may want to use such a situation as an opportunity to talk to parents about the child’s possible risk later on, said Dr. Diane Thiboutot, professor of dermatology at Penn State University College of Medicine in Hershey, Penn.

In addition, other factors could explain the results, Zane said.

For one, the diet of the patients could have influenced the laboratory analyses: It’s possible the patients did not always fast before their blood was drawn for triglyceride tests.

The next step will be to examine the clinical relevance of these side effects, and see if they lead to harmful diseases, Zane said.

Reprinted from UPI.com, in the “Consumer Health Daily – Reports” section.

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