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.

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. Linked Commentary: U. Gieler et al. J Eur Acad Dermatol Venereol 2020; 34: 1131–1133. https://doi.org/10.1111/jdv.16489. [ABSTRACT FROM AUTHOR]