Does oral isotretinoin cause IBD in acne patients?

Patients who use oral isotretinoin for a year or more may have an increased risk of developing irritable bowel disease (IBD).The topic of oral isotretinoin and possible links to IBD has been controversial, but new study in the Journal of the American Academy of Dermatology suggests that duration of use may be a key a factor. Oral isotretinoin has long been used to treat persistent moderate to severe acne, but various studies, mostly case series suggested possible risks.Reseachers did a meta-analysis to examine with with a focus on Crohn’s disease (CD) and ulcerative colitis (UC). It consisted of studies that compared the likelihood of new-onset IBD in placebo-controlled trials of isotretinoin to placebo. Nine studies met inclusion criteria and represented a combined total of 10,558,900 patients. All the studies except one had less than a year’s duration, and that study had more than 11,000 patients.The initial analyses showed only a marginal, non-significant increased risk of IBD among isotretinoin users. But when an outlier study was excluded, the association between IBD development and use of oral isotretinoin became significant. It also showed a slightly decreased risk for CD but no change in risk for UC compared to controls.But digging deeper and looking at the duration of treatment, the researchers found a different pattern. The paper stated there was “a significantly increased risk of IBD development (regardless of its type) for treatment duration of one year or more,” and that it had a number needed to harm of 194. However, for treatment that lasted under a year, there was no difference in the risk for developing IBD compared to the cohorts who did not use the drug.“While risk is not increased for shorter durations of treatment, extended use beyond one year may need to be considered carefully,” they concluded. The study results don’t entirely convince Dr. Charles Bernstein, from the University of Manitoba. “The authors excluded other studies so I am not sure how they cherry picked the ones they included,” he said.He noted that the study, for the most part, found no association, but from his point of view “I do not believe isotretinoin increase the risk for IBD.”In fact, he did a study on the same topic back in 2009 in the American Journal of Gastroenterology. It addressed the topic via a population-based study and was the first study to analyze the association between isotretinoin use and IBD beyond a case series.The researchers noted that while package inserts suggested IBD as a possible adverse reaction, IBD as a toxicity had not been routinely cited by recent expert reviews. And that a big risk with oral isotretinoin is teratogenicity, as well as possible associations with suicidal ideation, mood alterations and depression.Data were used from the Manitoba Health Administrative Databases and the University of Manitoba IBD Epidemiology Database. Cases were matched to controls of similar age, gender and area of residence. The purpose was to assess the likelihood that incident cases of IBD are more likely than controls to be treated with isotretinoin.IBD cases and controls with a case date for IBD after April, 1 1995, and who were under the age of 40 years when diagnosed were included. There were 2008 IBD cases, and of those 1,118 had CD and 890 had UC.“We found that 1.2% of IBD cases used isotretinoin before IBD diagnosis, which was statistically similar to controls (1.1% of users). This was also similar to the number of IBD patients who used isotretinoin after a diagnosis of IBD (1.1%). There was no difference between isotretinoin use before Crohn’s disease compared with its use before ulcerative colitis,” the paper said.The paper concluded that “there is no greater likelihood for isotretinoin use to be followed by a diagnosis of IBD than for isotretinoin to be used after IBD is diagnosed, or in a group of matched controls.”

Does oral isotretinoin cause IBD in acne patients?

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