IBD Not Associated With Isotretinoin Treatment for Acne

Isotretinoin therapy for acne is not associated with inflammatory bowel disease (IBD), according to study results published in American Journal of Clinical Dermatology.

Researchers conducted a systematic review and meta-analysis to assess the association between isotretinoin exposure and IBD. They searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase databases from inception until January 27, 2023, for relevant case-control or cohort studies.

A random-effects model meta-analysis was performed, and the outcome of interest was the respective pooled odds ratio (OR) with 95% confidence intervals (CI) for IBD and individually for Crohn disease (CD) and ulcerative colitis (UC). A trial sequential analysis (TSA) evaluated the robustness of the conclusiveness of the systematic review.

The analysis included 8 observational studies, including 4 case-control and 4 cohort studies, with 2,522,422 participants.

For the 8 studies, the meta-analysis found no association between isotretinoin exposure and IBD (pooled OR, 1.01; 95% CI, 0.80-1.27; I², 74%).

Regarding isotretinoin use and CD, 7 studies with 1,835,852 participants provided data. No significant association of isotretinoin exposure with CD was found (pooled OR, 0.87; 95% CI, 0.65-1.15; I², 59%). For UC, 7 studies with 1,842,069 participants provided data. No significant association between isotretinoin exposure with UC was observed (pooled OR, 1.27; 95% CI, 0.94-1.73; I², 62%).

A sensitivity analysis that excluded 1 low-quality study also found no association between isotretinoin exposure and IBD (pooled OR, 1.06; 95% CI, 0.85-1.32; I², 73%). A subgroup analysis of studies that included confounding from antibiotic use found no association between isotretinoin exposure and IBD (pooled OR, 0.92; 95% CI, 0.70-1.20; I², 68%).

Regarding the TSA sensitivity analysis, the last point of all Z-curves achieved the futility boundaries with use of relative risk reduction thresholds of 5% and 15%.

Limitations include the absence of relevant data to perform a subgroup analysis based on different sex and age subgroups.

“Previous case reports linking isotretinoin exposure with subsequent development of IBD might have caused unnecessary concern among clinicians and patients regarding the safety of isotretinoin, with resultant undertreatment,” conclude the study authors. “However, our meta-analysis with TSA does not support an association between isotretinoin exposure and IBD. Acne may not only cause permanent scars, but also lowers patients’ quality of life and increases anxiety.”