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T01-52 |
Print Media: 301-827-6242 |
October 31, 2001 |
Consumer Inquiries: 888-INFO-FDA |
FDA ANNOUNCES CHANGES
TO THE RISK MANAGEMENT PROGRAM TO
PREVENT BIRTH DEFECTS CAUSED BY ACCUTANE
The Food and Drug Administration (FDA) today is advising consumers
and health care providers about significant changes to the Accutane risk
management program for pregnancy prevention. The new program is called
S.M.A.R.T. (System to Manage Accutane Related Teratogenicity).
S.M.A.R.T. was developed in consultation with FDA by Accutane's
manufacturer, Roche Laboratories. The program is designed to enhance the
safe and appropriate use of Accutane by strengthening the existing
Accutane Pregnancy Prevention Program (PPP), a comprehensive patient
education program.
Accutane is approved to treat the most serious form of acne. This
form of acne is painful, permanently disfiguring, and does not respond to
other acne treatments. Accutane is very effective, but its use carries
significant potential risks, including birth defects and even fetal
death.
In recent years, as more women have been receiving prescriptions for
Accutane, the risk that pregnant women may be inappropriately using the
drug has increased. On September 18, 2000, the FDA held a meeting of its
Dermatologic and Ophthalmic Drugs Advisory Committee to discuss what
additional measures might help prevent exposure of unborn babies to
Accutane.
The S.M.A.R.T. program was developed to address the two main goals
identified at this meeting:
1) no woman should begin Accutane therapy if she is pregnant; and 2)
no pregnancies should occur while a woman is taking Accutane.
S.M.A.R.T. involves Accutane prescribers, patients, and pharmacists
in a partnership to prevent fetal exposure. The risk management
components are described fully within the boxed Contraindications and
Warnings (Black Box) and the Precautions sections of the Accutane package
insert, which provides prescribing information for healthcare
professionals.
The S.M.A.R.T. program requires the following:
- Prescribers must study the S.M.A.R.T.
"Guide to Best Practices"provided
by Roche, and then sign and return
to Roche the Letter of Understanding
certifying their knowledge of the
measures to minimize fetal exposures
to Accutane. The manufacturer has
also developed a Continuing Medical
Education (CME) course for prescribers
that includes specific, practical
information about pregnancy prevention.
FDA strongly encourages participation
in this half-day course. Prescribers
will then receive from Roche special
self-adhesive Accutane Qualification
Stickers. All prescriptions for
Accutane should have the special
yellow sticker attached to the
prescriber's regular prescription
form. This sticker will indicate
to the pharmacist that the patient
is "qualified"according
to the new package insert, which
means that the female patient has
had negative pregnancy tests as
described below, as well as education
and counseling about pregnancy
prevention. The pregnancy test
will be repeated every month throughout
the Accutane treatment course,
and no prescriptions should be
given for more than a one month
supply of Accutane at a time.
- ALL female patients must have
two negative urine or serum pregnancy
tests before the initial Accutane
prescription is written, and for
each month of therapy they must
have a negative pregnancy test
result before receiving their next
prescription, regardless of whether
they are sexually active. Patients
who are, or might become, sexually
active with a male partner must
also select and use two forms of
effective contraception simultaneously
for at least one month prior to
initiation of Accutane therapy,
during therapy, and for one month
following discontinuation of therapy.
They must sign a Patient Information/Consent
form about Accutane and birth defects,
in addition to the Consent Form
that all patients should receive
about other potentially serious
risks. Finally, female patients
must be given the opportunity to
enroll in the Accutane Survey.
This confidential Survey will collect
data to help Roche and FDA decide
if S.M.A.R.T. is helping to prevent
exposure of unborn babies to Accutane.
Patients who agree to participate
in the Survey will be making a
major contribution to the public
health by helping identify aspects
of S.M.A.R.T. that could be improved
as experience with it grows.
- Pharmacists will dispense Accutane
only upon presentation of a prescription
with the special Accutane Qualification
Sticker. Pharmacists will dispense
a maximum one-month supply of Accutane,
fill prescriptions within seven
days from the date of "qualification,"and
provide a Medication Guide for
patients with each Accutane prescription.
Requests for refills (i.e. more
Accutane without a new prescription)
and phoned-in prescriptions will
not be filled.
To measure the effectiveness of the S.M.A.R.T. program, Roche will
use several independent outcome assessment approaches. These include the
Accutane Survey, conducted by the Slone Epidemiology Unit of Boston
University School of Public Health, and an independent audit of
pharmacies to assess the use of Accutane Qualification Stickers by
prescribers. Prescribers, patients, and pharmacists all must participate
fully in these critically important measures to ensure that fetal
exposure to this potent teratogen does not occur.
Exposure of an unborn baby to Accutane
is a serious adverse event and should
be reported to Roche, or directly
to the FDA MedWatch Program. The
contacts are as follows: Roche Medical
Services 1-800-526-6367, FDA MedWatch
program 1-800-FDA-1088. MedWatch
can also be accessed via the Internet
at www.fda.gov/medwatch/index.html.
####
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