November 25, 2013
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Women treated with isotretinoin did not strictly adhere to contraception use or abstinence

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Women of childbearing potential who were being treated with isotretinoin did not always adhere to contraceptive methods or abstinence, according to recent study results.

Pregnancy must be avoided during isotretinoin treatment for women of childbearing years. However, according to Laura Korb Ferris, MD, PhD, assistant professor in the department of dermatology at the University of Pittsburgh School of Medicine, and fellow researchers, about 150 women became pregnant annually between 2008 and 2011 while being treated with isotretinoin for acne vulgaris, despite participating in the iPLEDGE  program, which requires monthly pregnancy tests, identification of contraceptive methods and qualifying questions for patients.

 

laura ferris 

Laura Korb Ferris

The researchers studied 75 women (median age, 25 years) of childbearing potential, per iPLEDGE guidelines, taking isotretinoin for at least two months. The women completed an anonymous 29-question survey including contraceptive choices during isotretinoin therapy, compliance with abstinence or contraception during therapy; reasons for noncomplicance; and demographic information.

Twenty-one women (28%) reported abstinence as their primary means of pregnancy prevention; of those women, 4 (19%) were sexually active during treatment with isotretinoin.

Among 39 women reporting having vaginal sex with men while on isotretinoin, condoms (n=35; 90%) and oral contraceptive pills (n=18; 46%) were the most common forms of contraception. Twelve women (31%) reported using one or fewer forms of contraception while having intercourse. Of those women, 10 reported not using the condoms they had agreed to use for contraception (29% noncompliance rate). One woman reported having unprotected sex.

Seven women (39%) who were sexually active and using oral contraceptive pills reported missing at least one pill dosage during the previous month.

Study limitations included self-reported data, in which the women might have inaccurately reported their contraception use, the researchers reported.

“Redirecting the focus of the iPLEDGE program to emphasize contraception adherence, limiting abstinence to those who have never been sexually active, and encouraging the use of a highly effective, long-acting reversible contraception that is minimally patient-dependent may further reduce isotretinoin-exposed pregnancies,” the researchers concluded.

Disclosure: Researcher Matthew Hastings, MSPAS, PA-C, received honoraria for serving on advisory boards with Genentech and Ranbaxy.