Isotretinoin treatment not associated with IBD development

There is no proof that using isotretinoin causes inflammatory bowel disease, says a recent meta-analysis by Chia-Ling Yu and colleagues at trial sequential analysis (TSA). The findings of this study were published in the American Journal of Clinical Dermatology.

Isotretinoin use has been linked to cases of inflammatory bowel disease (IBD), although it is not known if isotretinoin exposure causes IBD. Therefore, the purpose of this study was to determine if using isotretinoin is related to IBD.

From the beginning through January 27, 2023, the databases Embase, MEDLINE, and CENTRAL were searched for pertinent case-control and cohort studies. A pooled odds ratio (OR) for IBD and its two subtypes (Crohn's disease and ulcerative colitis) in connection to isotretinoin exposure was the study's key finding. By removing low-quality papers, a sensitivity analysis using the random-effects model was performed. We conducted a subgroup analysis by incorporating research on antibiotic usage. A trial sequence analysis was conducted to assess how reliable and conclusive our findings were.

The key findings of this study were:

1. With a total of 2,522,422 people, eight studies were considered for this (four case-control and four cohort studies).

2. Patients using isotretinoin did not have higher odds of developing IBD, according to the meta-analysis (OR 1.01; 95% confidence interval [CI] 0.80-1.27).

3. Additionally, the meta-analysis failed to discover any higher risks of ulcerative colitis (OR 1.27; 95% CI 0.94-1.73) or Crohn's disease (OR 0.87; 95% CI 0.65-1.15) in relation to isotretinoin exposure.

4. Results from the sensitivity and subgroup analyses were comparable.

5. When employing relative risk reduction levels between 5% and 15% in TSA, the Z-curve hit the futility bounds.

Reference:

Yu, C.-L., Chou, P.-Y., Liang, C.-S., Chiang, L.-H., Wang, T.-Y., Tu, Y.-K., & Chi, C.-C. (2023). Isotretinoin Exposure and Risk of Inflammatory Bowel Disease: A Systematic Review with Meta-Analysis and Trial Sequential Analysis. In American Journal of Clinical Dermatology. Springer Science and Business Media LLC. https://doi.org/10.1007/s40257-023-00765-9