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theg69 · 05-31-2013, 12:24 PM

People have to be careful re: causation and correlation.
There is no doubt that Accutane possesses many side effects and should be reserved for more serious cases of Acne.
I think Street Pharmacist did a very good job clarifying the side effects and the evidence to date. I apologize for the lengthy post - but I have posted the most recent evidence up to date re: inflammatory bowel disease and Accutane. The evidence is controversial and mixed. (see below)

For my patients, it is an individual decision, and I always refer them to a dermatologist for a second opinion (especially if they are female). While I do not favour its use, I have to admit that it is very effective and have seen some excellent results in some patients.

Someone mentioned that there are just as good medications with fewer side effects. The sad news is that this is false. There is nothing as good as Accutane in the treatment of acne. If it wasn't for the side effects, it would likely be routine therapy.

The following information is from a reliable source and meta-analyses are the best scientific studies - Inflammatory bowel disease includes Crohn's and Ulcerative colitis, while Isotretinoin is the generic name for Accutane:

Inflammatory bowel disease — Observational studies have found conflicting results on the relationship between isotretinoin therapy and inflammatory bowel disease (IBD). A 2012 meta-analysis of three case-control studies and two additional unpublished studies did not find a statistically significant relationship between isotretinoin therapy and IBD (relative risk for IBD 0.94, 95% CI 0.65-1.36) [37]. The individual results of the three published case-control studies and a subsequent population-based cohort study are briefly summarized below:

A nested case-control study of 2008 patients with IBD and 19,814 matched controls found similar rates of isotretinoin use among the IBD and control groups. In the study, 1.2 percent of patients in the IBD group received isotretinoin prior to a diagnosis of IBD, and 1.1 percent of patients in the control group received isotretinoin prior to the date of IBD diagnosis for the corresponding index patients with IBD (odds ratio [OR] 1.16, 95% CI 0.73-1.77) [38].
A nested case-control study of 2159 women with IBD and oral contraceptive use and 43,180 matched female controls found that isotretinoin treatment did not appear to increase the risk for IBD [37]. The study adjusted for potential confounders, including a diagnosis of acne and the use of oral tetracyclines (adjusted risk ratio for IBD 0.99, 95% CI 0.52-1.90).
A nested case-control study of 8189 subjects with IBD and 21,832 matched controls found an increase in risk for ulcerative colitis among patients who had received isotretinoin (OR 4.36, 95% CI 1.97-9.66) [39]. The absolute risk for the disease was small, estimated at 14 excess cases within a population of 4428 patients with ulcerative colitis. A statistically significant relationship between Crohn’s disease and isotretinoin treatment was not detected (OR 0.68, 95% CI 0.28-1.68).
A 12-year cohort study of 46,922 patients treated with isotretinoin, 184,824 patients treated with topical acne medication, and 1,526,946 untreated controls (all between the ages of 12 and 29) did not find a significant association between isotretinoin use and IBD on primary analysis (rate ratio 1.14, 95% CI 0.92-1.41) [40]. Although an association between isotretinoin and IBD was detected in a subgroup of patients aged 12 to 19 years (rate ratio 1.39, 95% CI 1.03-1.87), a similar association was detected between the use of topical acne medications and ulcerative colitis (rate ratio 1.19, 95% CI 1.00-1.42), suggesting that acne may contribute to risk for IBD. More studies are necessary to determine whether isotretinoin therapy is a risk factor for IBD. Until additional information is available, during discussions of the potential adverse effects of isotretinoin with patients, it is reasonable to mention that although an increased risk for IBD has been reported, a relationship between these disorders remains to be proven.

Hope that's informative!

05-31-2013, 12:24 PM	#56
theg69 Scoring Winger Join Date: Jul 2008 Exp:	People have to be careful re: causation and correlation. There is no doubt that Accutane possesses many side effects and should be reserved for more serious cases of Acne. I think Street Pharmacist did a very good job clarifying the side effects and the evidence to date. I apologize for the lengthy post - but I have posted the most recent evidence up to date re: inflammatory bowel disease and Accutane. The evidence is controversial and mixed. (see below) For my patients, it is an individual decision, and I always refer them to a dermatologist for a second opinion (especially if they are female). While I do not favour its use, I have to admit that it is very effective and have seen some excellent results in some patients. Someone mentioned that there are just as good medications with fewer side effects. The sad news is that this is false. There is nothing as good as Accutane in the treatment of acne. If it wasn't for the side effects, it would likely be routine therapy. The following information is from a reliable source and meta-analyses are the best scientific studies - Inflammatory bowel disease includes Crohn's and Ulcerative colitis, while Isotretinoin is the generic name for Accutane: Inflammatory bowel disease — Observational studies have found conflicting results on the relationship between isotretinoin therapy and inflammatory bowel disease (IBD). A 2012 meta-analysis of three case-control studies and two additional unpublished studies did not find a statistically significant relationship between isotretinoin therapy and IBD (relative risk for IBD 0.94, 95% CI 0.65-1.36) [37]. The individual results of the three published case-control studies and a subsequent population-based cohort study are briefly summarized below: A nested case-control study of 2008 patients with IBD and 19,814 matched controls found similar rates of isotretinoin use among the IBD and control groups. In the study, 1.2 percent of patients in the IBD group received isotretinoin prior to a diagnosis of IBD, and 1.1 percent of patients in the control group received isotretinoin prior to the date of IBD diagnosis for the corresponding index patients with IBD (odds ratio [OR] 1.16, 95% CI 0.73-1.77) [38]. A nested case-control study of 2159 women with IBD and oral contraceptive use and 43,180 matched female controls found that isotretinoin treatment did not appear to increase the risk for IBD [37]. The study adjusted for potential confounders, including a diagnosis of acne and the use of oral tetracyclines (adjusted risk ratio for IBD 0.99, 95% CI 0.52-1.90). A nested case-control study of 8189 subjects with IBD and 21,832 matched controls found an increase in risk for ulcerative colitis among patients who had received isotretinoin (OR 4.36, 95% CI 1.97-9.66) [39]. The absolute risk for the disease was small, estimated at 14 excess cases within a population of 4428 patients with ulcerative colitis. A statistically significant relationship between Crohn’s disease and isotretinoin treatment was not detected (OR 0.68, 95% CI 0.28-1.68). A 12-year cohort study of 46,922 patients treated with isotretinoin, 184,824 patients treated with topical acne medication, and 1,526,946 untreated controls (all between the ages of 12 and 29) did not find a significant association between isotretinoin use and IBD on primary analysis (rate ratio 1.14, 95% CI 0.92-1.41) [40]. Although an association between isotretinoin and IBD was detected in a subgroup of patients aged 12 to 19 years (rate ratio 1.39, 95% CI 1.03-1.87), a similar association was detected between the use of topical acne medications and ulcerative colitis (rate ratio 1.19, 95% CI 1.00-1.42), suggesting that acne may contribute to risk for IBD. More studies are necessary to determine whether isotretinoin therapy is a risk factor for IBD. Until additional information is available, during discussions of the potential adverse effects of isotretinoin with patients, it is reasonable to mention that although an increased risk for IBD has been reported, a relationship between these disorders remains to be proven. Hope that's informative!