Can we ensure the safe use of known human teratogens?: The iPLEDGE test case.
Minimising the public health burden of isotretinoin-induced teratogenicity has been a challenge for 24 years, the duration of availability of isotretinoin in the US for the treatment of severe, recalcitrant nodular acne. Although the teratogenicity of this drug is well known and risk-management programmes had been implemented, preventable fetal exposures continued to occur, largely as a result of the lack of sufficient controls within the programmes themselves. The manufacturers of isotretinoin implemented a new risk-management programme, iPLEDGE, in March 2006. iPLEDGE is a comprehensive distribution system that includes mandatory registration of patients, healthcare providers, pharmacies, and wholesalers. It allows real-time linkage of pregnancy-test results for verification prior to the dispensing of isotretinoin. Although the challenges of implementing a closed distribution system for a very widely used medication have been extensive, the potential public health benefits from preventing fetal exposure to isotretinoin are substantial.
Honein
Margaret A
MA
National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Lindstrom
Jill A
JA
Kweder
Sandra L
SL
D000152:Acne Vulgaris / Q000188:drug therapy; D016907:Adverse Drug Reaction Reporting Systems / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D015474:Isotretinoin / Q000009:adverse effects* / Q000627:therapeutic use; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data
D003879:Dermatologic Agents; D015474:Isotretinoin