Prescriptions of spironolactone for women with acne increased substantially among dermatologists, NP/PAs, and non-dermatology clinicians from 2017 - 2020, according to new findings, and oral antibiotics continue to be commonly prescribed by dermatologists as well as non-dermatologists.¹

These and other findings were the conclusions of a recent research letter, authored and conducted by John S. Barbieri, MD, MBA, from the Department of Dermatology at Brigham and Women’s Hospital in Boston.

Previous research has suggested that oral antibiotics are often recommended as the primary systemic remedy for acne, and these decisions especially have been made by those who are not dermatology specialists.²

“Due to concerns about antibiotic overuse, there has been interest in considering alternatives such as hormonal therapy and earlier initiation of isotretinoin,” Barbieri wrote. “However, little is known about more recent trends in prescribing patterns of systemic treatments.”

This research letter by Barbieri highlighted some of these prescribing trends since the year 2017, expanding upon existing knowledge of the topic.

Background and Findings

Barbieri utilized a repeated cross-sectional study design, adhering to the relevant components of the STROBE reporting guideline. He also used the Truven Health MarketScan Commercial Claims Database, the contents of which span from January of 2017 to December of 2020.

The research was aimed at individuals with recorded acne-related encounters as well as prescriptions which had been observed thanks to National Drug Code Numbers for several different medications. These included oral tetracycline antibiotics such as doxycycline and minocycline.

They also included oral antibiotics which were frequently-prescribed such as trimethoprim-sulfamethoxazole [TMP-SMX], amoxicillin and cephalexin. Some other oral antibiotics were isotretinoin and spironolactone.

Barbieri consolidated prescriptions into treatment courses when the included prescriptions were spaced by fewer than 30 days total, with Barbieri considering possible non-adherence to long-term medications. In order to make sure that only acne-related indications were included, he only considered courses which took more than 28 days.

Barbieri’s data analysis was carried out between March 1, 2023, and May 4, 2023. The included encounters were categorized by him through a record of clinician type: non-dermatologist clinicians (internal medicine, family medicine, pediatrics), dermatology clinicians, and nurse-practitioner or physician assistant (NP or PA).

For the research to account for possible changes in the total number of participants undergoing acne treatment over time, Barbieri standardized prescribing rates by relating the total number of courses of therapy prescribed yearly to the number of acne-related meetings linked to that specific physician type in the same calendar year.

During the period of the study’s investigation from 2017 - 2020, with an average of 1.9 million instances of acne-related meetings per year, Barbieri reported a significant 3- to 4-fold increase in the prescribing rates for spironolactone, observed across dermatologists, NP/PAs, and non-dermatologists.

In the beginning year of the research, oral antibiotics were found to have been prescribed around 2- to 3-fold more commonly than spironolactone; however, by the final year of 2020, they were being prescribed at similar rates. Interestingly, non-dermatology physicians and NP/PAs were found to be somewhat more inclined to choose to prescribe oral antibiotics.

During the 2017 -2020 timeframe, the prescription of isotretinoin was also found to have had a small decrease over both male and female acne patients. When assessing antibiotic prescriptions, Barbieri noted that while overall antibiotic prescription rates increased over all of the types, doxycycline was shown to have had a more substantial increase in prescription versus minocycline, especially among dermatology physicians as well as NPs or PAs.

“These results highlight that spironolactone was increasingly prescribed for women with acne, both among dermatologists and nondermatologists,” Barbieri wrote. “Given spironolactone may have similar effectiveness to oral antibiotics in the treatment of acne, this shift in practice has the potential to improve outcomes for patients by reducing the risk of antibiotic-associated complications.”

References

1. ^{Barbieri JS. Temporal Trends in the Use of Systemic Medications for Acne From 2017 to 2020. JAMA Dermatol. Published online August 16, 2023. doi:10.1001/jamadermatol.2023.2363.}
2. ^{Barbieri JS, James WD, Margolis DJ. Trends in prescribing behavior of systemic agents used in the treatment of acne among dermatologists and nondermatologists: a retrospective analysis, 2004-2013. J Am Acad Dermatol. 2017;77(3):456-463.e4. doi:10.1016/j.jaad.2017.04.016.}