For young, healthy women taking spironolactone to treat hormonal acne, frequent office visits and blood draws are an unnecessary health care expense, according to a study published online March 22 in JAMA Dermatology and presented at the 73rd Annual Meeting of the American Academy of Dermatology (AAD).
For the approximately 1,000 patients studied, blood tests to monitor potassium levels did not change the course of treatment.
The research team suggests that routine potassium monitoring should no longer be recommended for this patient population in order to improve the patient care experience, decrease unnecessary office visits and reduce healthcare spending.
"The need for testing may be a deterrent for both physicians and patients alike," said senior author Arash Mostaghimi, MD, Dermatology Inpatient Service, Brigham and Women's Hospital, Boston, Massachusetts. "By demonstrating that for young, healthy women, it's safe to give spironolactone without close potassium monitoring, we hope that more patients will be able to benefit from this medication."
Spironolactonès primary use is as a diuretic and antihypertensive treatment for patients with heart failure and liver failure. In these patients, spironolactone has been associated with an increased risk of hyperkalaemia. Based on this risk, the US Food and Drug Administration (FDA) recommends frequent potassium monitoring in patients with heart failure taking spironolactone, but it's been unclear if these guidelines should apply to healthy patients taking spironolactone for the treatment of acne, and, if so, how frequently such patients should have their potassium levels tested.
Dr. Mostaghimi and colleagues evaluated clinical data from patients seen at Massachusetts General Hospital and Brigham and Women's Hospital over a 15-year period. They calculated how frequently individual patients were tested and the rate of hyperkalaemia.
"Our goal was to understand the current screening practices of physicians taking care of young, healthy women on spironolactone for acne and to determine what the usefulness of the test was," said Dr. Mostaghimi. "What we found was that doctors checked potassium levels at different frequencies, suggesting ambivalence about the tests. Of the more than 1,800 blood tests administered over that time period, we found no substantial problems or complications for these patients and no changes in their treatment based on what the tests showed."
The researchers found just 13 cases of mild hyperkalaemia. When tested a second time, half of these patients had normal potassium levels, and none of the patients showed any signs or symptoms of hyperkalaemia.
"There are two ways to think about cost," said Dr. Mostaghimi. "The first is in terms of money spent - that's almost $80,000 [USD] worth of testing done without any benefit in terms of patient treatment. But there are also the time and psychological costs of being monitored while taking a medication. Therès time and lost work productivity to consider too. We hope that by presenting these data, we will begin to create a standard of practice that best serves patients and helps physicians who may be ambivalent about recommending these tests for otherwise healthy patients."