Measuring the rate of patients’ deliberate circumvention of iPledge pregnancy testing

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To the Editor: The iPledge program was developed to prevent adverse fetal outcomes due to isotretinoin’s severe teratogenicity. It requires monthly pregnancy tests, usually performed using urinalysis or serology in the physician’s office. Although iPledge implementation varies by country, on-therapy pregnancies have occurred in the United States and Europe (143 cases in 22 European countries in 2003-2004),1 and studies have tried to evaluate the reasons for its failure,2 including assessing the problems related to implementation and program information readability.