A study published in Drug Safety found that fetal exposure to acne treatments varied according to levels of teratogenicity, including reduced rates for isotretinoin and even less with doxycycline/minocycline.
The study acknowledged that there are several studies in which the effects of changes in isotretinoin risk mitigation programs have been evaluated; however, little is known about actual fetal exposure rates in the context of additional therapies for acne. The authors looked at the insurance claims data of more than 100,000 acne treatment users between 2006 and 2015. The data were divided into three cohorts:isotretinoin (strong teratogen/mandatory risk mitigation program), doxycycline/minocycline (mild teratogen, label warning), and topical clindamycin/erythromycin (no fetal risk). This data were used to calculate fetal exposure rates overall as well as rates stratified by age, which were compared after adjustments for potential confounders.
Per the results, contraceptive use during acne treatment was less than 50% in isotretinoin users and less than 30% in the other study groups. Approximately 90% of patients used oral contraceptives vs 1% that used long-acting contraceptives. Patients who used isotretinoin experienced 19.2 (95% CI, 20.3-17.9) fewer fetal exposures per 1000 person years of use. Further, doxycycline/minocycline was associated with 28.8 (95% CI, 31.2-26.3) fewer pregnancies than clindamycin/erythromycin. The study noted that stratification by age showed attenuated differences in fetal exposure among acne treatment groups for teenagers.
“Fetal exposure to acne treatments varied according to levels of teratogenicity,” concluded the authors. They also stated that teenagers had low pregnancy rates but less pronounced differences in fetal exposure across acne treatments.—Jessica Garlewicz
Albogami Y, Sarayani A, Hincapie-Castillo JM, Winterstein AG. Real-world fetal exposure to acne treatments in the United States: a retrospective analysis from 2006 to 2015. Drug Saf. Published online March 8, 2021. doi:10.1007/s40264-021-01053-3