Isotretinoin and risk factors for suicide attempt: a population-based comprehensive case series and nested case-control study using 2010-2014 French Health Insurance Data

Catherine Droitcourt (1, 2, 3, 4) , Florence Poizeau (1, 3, 4) , Sandrine Kerbrat (3, 4) , Frédéric Balusson (3) , Erwan Drezen (3) , André Happe (3, 4) , David Travers , Emmanuel Oger (3, 4) , Alain Dupuy (1, 3, 4)

1 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
2 CIC - Centre d'Investigation Clinique [Rennes]
3 REPERES - Recherche en Pharmaco-épidémiologie et Recours aux Soins
4 PEPS - Pharmaco-Épidémiologie des Produits de Santé

BACKGROUND: Although the causal role of isotretinoin in suicidal behaviour is controversial, suicide attempts (SA) do occur among patients taking isotretinoin.OBJECTIVES: To describe patient profiles and the management of isotretinoin among patients who committed or attempted suicide under treatment. To assess the risk factors for SA under isotretinoin.METHODS: We performed a comprehensive case series of suicides and SAs under isotretinoin, and a case-control study, using Nationwide French Health Insurance database. The main analysis compared cases (subjects with a SA during a course of isotretinoin) to controls, individually matched for age, gender and rank of the current course; controls were to be exposed to isotretinoin at the index date (date of SA for the corresponding cases). The patients' psychiatric history at isotretinoin initiation was studied. In a secondary analysis, patients who continued their isotretinoin treatment after their SA were compared to patients who discontinued it.RESULTS: In all, 328 018 subjects started a course of isotretinoin between 1 January 2010 and 31 December 2014 and 184 patients were hospitalized for a SA; half of them had a psychiatric history at initiation. In the multivariate analysis, psychiatric history and history of anxiety alone were risk factors for SA [Odds ratio (OR), 18.21; 95% confidence interval (CI), 9.96-33.30 and 4.78; 95% CI, 2.44-9.33, respectively]. Among 176 cases of SA with sufficient follow-up, 103 (58.5%) carried on with their treatment after their SA. Treatment initiation by a dermatologist was inversely associated with the continuation of the treatment after a SA (OR, 0.38; 95% CI, 0.18-0.80).CONCLUSIONS: Suicide attempts under isotretinoin are rare events, and our results suggest that most of the patients concerned have a risk-prone profile detectable at the time of treatment initiation. The risk-benefit ratio of continuing isotretinoin after a SA warrants further careful evaluation.

Mots clés: suicide attempt; acne; isotretinoin

Domaines: Pharmacologie; Santé publique et épidémiologie; Dermatologie; Psychiatrie et santé mentale

Catherine Droitcourt, Florence Poizeau, Sandrine Kerbrat, Frédéric Balusson, Erwan Drezen, et al.. Isotretinoin and risk factors for suicide attempt: a population-based comprehensive case series and nested case-control study using 2010-2014 French Health Insurance Data. Journal of the European Academy of Dermatology and Venereology, 2020, 34 (6), pp.1293-1301. ⟨10.1111/jdv.16005⟩. ⟨hal-02363653⟩