FDA high-tech system to monitor Accutane


WASHINGTON - Federal regulators unveiled yesterday a high-tech system to restrict distribution of Accutane, a drug that has been effective against severe acne but has long been known to cause birth defects and is being studied for a possible connection to teen suicides.

Patients, doctors, pharmacists, wholesalers and manufacturers all will be required by the Food and Drug Administration to enroll and participate in an Internet-based tracking system primarily designed to ensure that women don't get pregnant while taking Accutane.

Women of childbearing age will be required to submit the results of monthly pregnancy tests, and all patients will have to acknowledge that they understand the potential for psychiatric side effects, which will also be emphasized in stronger warning language.

Although welcomed by some experts, the FDA actions are unlikely to satisfy critics who say the agency has neglected its duty as a drug safety watchdog. Accutane has been on the market for many years, and these critics say the measures the FDA has taken will not keep doctors from prescribing it to patients who may not need it.

Accutane was one of five drugs named last fall in congressional testimony by FDA whistleblower Dr. David Graham as deserving a critical re-examination of their risks and benefits.

In an interview yesterday, Graham questioned whether the new monitoring program would work. "It will not sufficiently reduce the use of Accutane for less severe forms of acne," said Graham, a drug safety officer.

"A restricted distribution system should have been in place 15 years ago, and FDA scientists from both the drug safety office and the [drug] reviewing division were urging that it be adopted," he added.

It is fairly common for regulators to restrict access to powerful drugs, and patient registries are a standard tool for monitoring safety, but a computerized system involving so many players is new territory for the FDA.

'Long overdue'

"This is a system long in the works, and many would say it is long overdue," said Dr. Sandra Kweder, deputy director of the FDA's Office of New Drugs. "The responsibility that fetuses not be exposed to this medicine is enormous and is shared by everyone who participates" in distributing, prescribing, or taking the drug.

About 100,000 prescriptions a month are written for Accutane or its generic equivalent, isotretinoin. Although the FDA says it should only be used to treat a disfiguring condition known as severe recalcitrant nodular acne, doctors are free to prescribe it as they judge best.

Experts say an estimated 3,000 to 4,000 women a year get pregnant while taking Accutane, and most decide to have abortions. "The FDA and the [manufacturers] have relied on abortion as the risk management program for this drug," Graham said.

Other experts said the actions were an encouraging sign.

A more comprehensive tracking system was needed because current efforts have not been effective in keeping women from getting pregnant while using the drug, said Dr. Brian Strom, chairman of the biostatistics and epidemiology department at the University of Pennsylvania School of Medicine.

'Health dilemma'

"This has been a public health dilemma," said Strom. "It is an extraordinarily effective drug. Simply put, you take it for four months and your acne goes away for life. But it's also extremely effective at causing birth defects. How many birth defects and how many abortions are acceptable? But the flip side is, do you deny this drug to men and women who are responsible about how they take it?"

Strom was a member of an FDA advisory committee that recommended more than a year ago much more stringent precautions for patients taking Accutane, including monthly pregnancy tests.

The new tracking system, "iPledge" takes effect Dec. 31.

The Los Angeles Times is a Tribune Publishing newspaper.

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