About the project
The project aims to give an updated description of the treatment of acne in Norway and to evaluate whether it is safe for GPs to prescribe isotretinoin. The project consists of three sub-projects that will constitute a ph.d.-degree.
Objectives
The primary objective of this study is to contribute knowledge that will enable more GPs to optimize the treatment of acne. Specifically, we aim to provide an updated population-based overview of the current treatment landscape for acne in Norway, with a focus on the role of GPs in prescribing topical treatments, systemic tetracyclines, and isotretinoin.
To achieve this objective, we plan to examine the different courses of treatment being used for acne, as well as to characterize the patients who are receiving each treatment course. We will also investigate the characteristics of GPs who prescribe isotretinoin and compare them to those who do not prescribe this medication.
Finally, we will investigate the safety of isotretinoin treatment when initiated by GPs compared to when it is initiated by dermatologists. Specifically, we will examine whether there is a difference in the incidence of severe unwanted events associated with isotretinoin treatment depending on whether it is initiated by a GP or a dermatologist.
Overall, the results of this study will help to inform best practices for the treatment of acne and enable more GPs to provide optimal care for their patients.
Background
Acne vulgaris, or simply acne, is a common skin condition that is frequently encountered in general practice. It is estimated that 85% of young people experience acne, with 15-20% having moderate to severe cases. Unfortunately, those with acne are also more likely to report feelings of depression and anxiety compared to their peers. While long-term tetracycline-use has been a well-established treatment for acne, courses are often longer than recommended, and this practice is contributing to increasing antibiotic resistance worldwide. Given the global goal to reduce unnecessary use of antibiotics, it is important to explore alternative treatments for acne. One such treatment is isotretinoin, which has proven effective but is also associated with a number of side effects. In Norway, GPs are now authorized to prescribe isotretinoin, but it is unclear how often this practice is utilized. It is important to understand which GPs initiate this treatment and how they prescribe it in order to expand the number of GPs who can competently perform this task. Furthermore, it is unknown whether GPs who prescribe isotretinoin also prescribe fewer antibiotics for the treatment of acne, and whether there are more instances of unwanted side effects associated with GPs initiating isotretinoin treatment compared to dermatologists.
Sub-projects
- Sub-study 1 is a quantitative descriptive study of prescription data for acne treatment in Norway from 2012-2019, providing an overview of the amount of medication prescribed, the combinations used, and the number of general practitioners prescribing isotretinoin. We will use data from the KUHR database, the Prescription Register, and the General Practitioner Register.
- Sub-study 2 aims to describe different treatment courses for patients and identify predictors of different outcomes. We want to investigate whether there are different treatment courses depending on whether patients have general practitioners who initiate isotretinoin or not. Additionally, we want to see if the prescribing of isotretinoin by general practitioners affects their prescribing of antibiotics. We will use registry data from the KUHR database, the Norwegian Patient Registry, the Prescription Register, the General Practitioner Register, and Statistics Norway.
- With sub-study 3, we aim to determine whether isotretinoin prescribing by general practitioners is as safe as isotretinoin prescribing by dermatologists. We will investigate whether there is an increased incidence of suicide, psychiatric hospitalizations, or pregnancy during isotretinoin treatment initiated by general practitioners. We will use registry data from the KUHR database, the Norwegian Patient Registry, the Prescription Register, the General Practitioner Register, the Abortion Register, the Medical Birth Register, and the Cause of Death Register.
Financing
Allmennmedisinsk forskningsfond (AMFF)
Project start and finish
2023-2028