USA: Potassium Monitoring in Young Women Treated with Spironolactone

Potassium monitoring remains common in healthy young women being treated with spironolactone for acne, finds a recent study in the journal JAMA Dermatology. This is occurring despite increasing evidence and guidelines supporting the elimination of potassium monitoring in this population.

"There is a need for future efforts to understand underlying factors for the variation and develop strategies for addressing this practice gap," wrote the authors.

The recent studies and guidelines have suggested potassium level monitoring to be of low usefulness for healthy young women being treated with spironolactone for acne. Not much is known if these recommendations are being implemented in clinical practice. To address this knowledge gap, John S. Barbieri, University of Pennsylvania, Philadelphia, and colleagues aimed to evaluate trends in rates of potassium level monitoring among young women treated for acne with spironolactone and clinician variability in monitoring practices.

For the purpose, the researchers conducted a retrospective cohort study using data from the Optum deidentified Clinformatics Data Mart database. Participants included 108,547 healthy female patients (aged 12-45 years) who were treated for acne with spironolactone.

The primary outcome was the proportion of women who received a test for baseline potassium level and the proportion of women whose potassium levels were monitored in the first 180 days of being treated for acne with spironolactone.

For clinicians who had prescribed at least 5 courses of spironolactone, the percentage of clinicians who ordered baseline potassium testing or monitoring and the percentage of clinicians who always monitored potassium were compared between 2008 and 2015 vs between 2016 and 2018.

Key Findings of the Study

• Between 2008 and 2018, the percentage of women whose potassium levels were monitored within 180 days of starting spironolactone by all clinicians decreased from 41.4% to 38.5%, with a decrease from 48.9% to 41.0% among dermatologists and from 39.7% to 37.7% among internists but with an increase from 71.4% to 75.4% among advanced practice clinicians (i.e., nurse practitioners and physician assistants).
• The proportion of dermatologists who always monitored potassium decreased from 10.6% between 2008 and 2015 to 4.2% between 2016 and 2018.
• There was no significant difference in the proportion of internists who always monitored potassium from 2008 to 2015 (15.8%) vs from 2016 to 2018 (17.7%).

"This study finds that potassium level monitoring remains common among with substantial variability in clinician practices in young women treated for acne with spironolactone despite increasing evidence and guidelines supporting the elimination of potassium," wrote the authors.

"There is a need for future implementation and dissemination research to understand underlying factors for this variation and to develop strategies to address this practice gap," they concluded.

The study titled, "Temporal Trends and Clinician Variability in Potassium Monitoring of Healthy Young Women Treated for Acne With Spironolactone," is published in the journal JAMA Dermatology.

DOI: https://jamanetwork.com/journals/jamadermatology/article-abstract/2775574