In Reply We thank Pousti and Mollanazar for their interest in our study and for furthering the discussion surrounding the burden and need for improvement of iPLEDGE’s stringent requirements. Our work1 aimed to describe fetal exposure to isotretinoin in the iPLEDGE era. We found that although the number of pregnancy-related adverse events has declined since the implementation of iPLEDGE in 2006, rates have remained steady since 2010. Patients continue to have adverse outcomes despite the imposition of iPLEDGE on all parties involved, underscoring the need for further objective evaluation of this system.1
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Tkachenko E, Singer S, Mostaghimi A. Contradictory iPledge Requirements Hinder Physician Practice and Patient Care—Reply. JAMA Dermatol. 2020;156(2):222–223. doi:10.1001/jamadermatol.2019.3651
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