Sunday, March 5, 2017

Acne Treatment Trials May Be Too Short


Patients with acne typically see their dermatologist for treatment longer than most studies have assessed the benefits of acne therapy, researchers reported here.

In a retrospective study, the mean duration of treatment for acne was 0.79 years (about 9 months) and half of patients stopped going to the dermatologist after 0.44 years, reported Karen Huang, MS, of Wake Forest School of Medicine in Winston-Salem, N.C., and colleagues during a late-breaking session at the American Academy of Dermatology meeting.

"We found that half of patients continue to visit the dermatologist for acne at least 0.44 years, but, in contrast, many clinical trials are a lot shorter," Huang said, noting that a review of the 40 most recent acne studies listed in showed that they were typically only 12 weeks or 3 months long.

"It may be of interest in the future to design clinical trials that more closely simulate how long an average patient is treated," she added.

Overall, about 85% to 90% of people will have acne at some point in their lifetime, but the duration of an acne episode is not well characterized.

So Huang and colleagues looked at electronic records from Wake Forest Baptist Hospital between Jan. 1, 2009 and Nov. 15, 2012 to assess how long patients typically visited the dermatologist for acne treatment.

accutane resultsThey calculated the difference between the patient's first and last visit during that time, and to control for whether patients completed all their acne treatment by the cutoff point, they censored those who had a visit in the 3 months prior to that time, assuming they may still be seeing the doctor.

Huang noted that the analysis looked at the duration of care rather than how long the acne itself persisted.

There were 2,250 patients who had at least one visit for acne. Of these, 57% had only one visit while 43% had multiple visits. The censoring rates were similar between groups.

Overall, 25% of patients continued to see their dermatologist for 1 year.

When assessed by treatment, patients were more likely to have multiple visits if they were taking isotretinoin products (such as Accutane) or non-isotretinoin oral products.

They also found that visits fall off significantly more rapidly for isotretinoin products than for topical or other oral products, which have a much more gradual depletion of patients, Huang said (P=0.004).

Huang noted that if clinicians help patients set expectations of what their treatment may be like, it could help improve adherence.

doctor7online.comThe results are generalizable to patients in an academic dermatology setting and possibly to private practice settings, but may not be applicable in primary care, she noted.

The study was limited by the fact that it may have missed over-the-counter oral medications that were not recorded in medical records, so the study may not as effectively characterize the topical products group.

Also, it provides a "good lower bound," Huang said, but it's possible that patients may only visit the dermatologist once or twice until they are referred back to primary care clinicians.

Richard Gallo, MD, PhD, of the University of California San Diego, who moderated the session at which the findings were presented, noted that the study had two potential confounding variables.

One is the efficacy of the therapy, as patients may stop treatment because they're better, Gallo said. The other is the severity of the initial diagnosis, as patients with mild acne may garner benefit from topical therapy and discontinue seeing their doctor.