Isotretinoin may increase risk of ulcerative colitis but not Crohn's disease and IBS

A controversy exists between the risk of inflammatory bowel disease and Isotretinoin. There needs to be more data and investigations required to determine the burden of isotretinoin-related irritable bowel syndrome.

A team of researchers led by Khalaf Kridin, MD, PhD, Lübeck Institute of Experimental Dermatology, evaluated the risk of Crohn's disease, ulcerative colitis (UC), and irritable bowel syndrome in patients who presented with acne and started Isotretinoin vs oral antibiotics treatment.

The study summary includes the following:

• This was a global population-based retrospective cohort study.
• There were two groups: 77,005 patients with acne-initiating Isotretinoin and 77,005 patients with oral antibiotics. Comprehensive propensity-score matching was conducted.
• The lifetime risk of Crohn's disease and UC was comparable between study groups with hazard ratios of 1.05 and 1.13, respectively.
• The lifetime risk of irritable bowel syndrome was lower in isotretinoin-prescribed patients having an HR of 0.8.
• The isotretinoin-related risk of UC was increased during the first six months after drug initiation with an HR of 1.93. but decreased afterwards to level the risk of the comparator group. (time-stratified analysis).
• There was a clinically marginal absolute risk difference within the first six months (5.0 additional UC cases/10,000 patients starting Isotretinoin)

The researchers evaluated the outcomes in patients with acne undergoing treatment with Isotretinoin versus those on oral antibiotics.

They said we found a marginal increase in the risk of a diagnosis of ulcerative colitis (UC) during the first six months of isotretinoin treatment.

There was no increase in the risk of Crohn's disease.

Patients treated with Isotretinoin had a lower risk of irritable bowel syndrome.

Kridin, Khalaf, and Ralf J. Ludwig. "Isotretinoin and the Risk of Inflammatory Bowel Disease and Irritable Bowel Syndrome: A Large-scale Global Study." Journal of the American Academy of Dermatology, Elsevier BV, Dec. 2022. Crossref,

https://doi.org/10.1016/j.jaad.2022.12.015