Isotretinoin may decrease inflammatory bowel disease risk

1. Patients who took isotretinoin had a lower risk of developing inflammatory bowel disease (IBD) compared to the non-exposed group.     

Evidence Rating Level: 2 (Good)

Study Rundown: Isotretinoin is commonly used for the treatment of severe nodulocystic acne, secondary to an unknown mechanism that likely involves regulation of cell proliferation and apoptosis. Previous studies have suggested a possible link between isotretinoin exposure and the subsequent development of inflammatory bowel disease (IBD); however, the relationship between the two is not well understood. In this study authors found that isotretinoin exposure was associated with a decreased, not increased, risk of IBD. Despite the inherent strength of the cohort study design, comparing both patients who were and were not exposed to the drug, the study was limited by the small number of IBD cases. Future research aimed at elucidating the possibility that isotretinoin may have anti-inflammatory properties and could be protective against inflammatory diseases may be warranted.

Click to read the study in JAMA Dermatology

Relevant Reading: Isotretinoin Therapy and Inflammatory Bowel Disease

In-Depth [retrospective cohort study]: 576 patients who were exposed to isotretinoin and 502 patients who were non-exposed (the non-exposed group consisted of both never exposed and those exposed after IBD diagnosis) were selected and were found to have comparable baseline characteristics such as systemic antibiotic use, race, family history of IBD. There were more females in the exposed vs. non-exposed group (73.3% vs. 60.1%, p<.001). Researchers then searched the medical record using both ICD-9 codes for Crohn’s disease and ulcerative colitis, and also searched through notes using keywords such as “Crohn’s” and “ulcerative colitis” to identify patients who were subsequently diagnosed with IBD. 5 of 576 patients exposed to isotretinoin were subsequently diagnosed with IBD, as compared to 13 of 502 non-exposed patients (.09% vs. 2.6%, p=.03). After accounting for gender and non-acne indications, this negative association between exposure and disease was still statistically significant OR 0.28, (95%CI 0.10-0.79, p=.02).

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