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Women Treated with Spironolactone Still Undergoing Potassium Monitoring Despite Opposing Evidence

According to an article published in JAMA Dermatology, a cohort study revealed potassium monitoring is still prevalent in clinical practices regardless of sufficient evidence supporting the cessation of this practice.

This retrospective cohort study was executed using deidentified data from the Clinformatics Data Mart between January 1, 2008, to June 30, 2019. In total, 108,547 female patients (age range, 12-45 years) who were treated with spironolactone for acne were included. The study sought to quantify women who received a potassium level baseline test as well as women who were monitored within the first 180 days after starting spironolactone. The researchers also analyzed the percentages of clinicians who prescribed at least five courses of spironolactone, who ordered baseline potassium testing/monitoring, and who chose to always monitor potassium levels. These percentages were then compared between two timeframes, 2008-2015 vs 2016-2018.

The study found that for the overall study period (2008-2018), the percentage of women who underwent potassium monitoring within 180 days of starting spironolactone by all clinicians was 38.5%, decreasing from 41.4% over the decade. In particular, there was a  decrease in initial testing among dermatologists (from 48.9% to 41.0%) and internists (39.7% to 37.7%), but there was an increase from 71.4% to 75.4% among advanced practice clinicians.

In addition, the number of dermatologists who typically monitor potassium lowered significantly to 4.2% between 2016 and 2018—a considerable decrease from the 10.6% between 2008 and 2015. In contrast, there was no significant difference in internists who frequently monitored potassium during 2008 to 2015 (15.8%) vs 2016 to 2018 (17.7%).

As a result, the findings confirm that the practice of potassium level monitoring continues to be prevalent in clinician practices. The authors note efforts must be made to address the division between research and the variability within the practices. Jessica Garlewicz

Barbieri JS, Margolis DJ, Mostaghimi A. Temporal trends and clinician variability in potassium monitoring of healthy young women treated for acne with spironolactone. JAMA Dermatol. Published online January 27, 2021. doi:10.1001/jamadermatol.2020.5468


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