New research suggests that increasing cumulative isotretinoin dosage could significantly reduce acne recurrence and the need for retreatment, offering hope for long-term skin clarity.
Study: Acne Relapse and Isotretinoin Retrial in Patients With Acne. Image Credit: New Africa / Shutterstock.com
A recent JAMA Dermatology study assesses the factors associated with relapse after isotretinoin treatment for acne.
Isotretinoin treatment for acne
Isotretinoin, commonly called Accutane, is the only approved treatment for severe acne. Although isotretinoin is extremely effective in most individuals with acne, some experience recurrence. As a result, patients who are vulnerable to acne relapse are treated with additional courses of isotretinoin.
It is pivotal to understand whether certain factors, such as patient characteristics, isotretinoin dosage, and treatment regimen, influence acne relapse. This information can be used to design optimal isotretinoin treatment regimens that maximize treatment outcomes and minimize adverse effects. An improved understanding will also enable clinicians to better manage patients’ expectations of treatment outcomes, including the possibility of relapse, and formulate effective maintenance treatment plans.
Previous studies have documented acne relapse rates ranging between 9.4% and 65.4%, with 1.7-23.1% using isotretinoin repeatedly. This variability has been attributed to unrepresentative populations, incomplete follow-up, small sample sizes, and varying isotretinoin dosage regimens. Inconsistency in definitions of acne relapse may also contribute to discrepancies in clinical reports.
About the study
The current study’s researchers investigated the frequency of acne recurrence after isotretinoin treatment and factors that may increase the risk of acne relapse. All data were obtained from the MarketScan commercial claims database between January 1, 2017, and December 31, 2020.
The analysis included patients with at least one acne diagnosis according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code. All patients were 12 years or older and received isotretinoin treatment for acne.
The index date reflected the date the first isotretinoin course was completed. Prescriptions were also analyzed to determine isotretinoin treatment regimens.
Acne relapse was identified when a patient was prescribed for systemic acne treatment with oral antibiotics like doxycycline, minocycline, trimethoprim-sulfamethoxazole, amoxicillin, cephalexin, spironolactone, and isotretinoin for a recent acne encounter. Isotretinoin retrial was also determined based on an individual receiving another prescription for isotretinoin after the index date.
Study findings
The study included 1,856,012 patients with acne, 19,907 females and 9,403 males. The average duration of initial isotretinoin courses prescribed by dermatologists was 5.6 months, with a maximum daily dose of 0.93 mg/kg/d and a cumulative dosage of 132.4 mg/kg. The mean follow-up period for this treatment was 24.9 months.
In this study cohort, 19,907 patients reported acne relapse, which amounted to a rate of acne relapse of 12.9 for every 100 person-years. The median time to acne relapse was 7.5 months.
About 2.1%, 25.8%, 15.6%, 25.2%, and 31.3% of patients were prescribed a systemic acne prescription within one month, one to three months, three to six months, six to twelve months, and over twelve months, respectively, from the index date.
Patients with acne relapse were frequently treated with oral antibiotics after isotretinoin regime completion. Cox proportional hazards regression modeling revealed that, as compared to males, females were at a significantly higher risk of acne relapse. The cumulative dosage of isotretinoin was also associated with a significantly decreased rate of acne relapse.
Approximately 8.2% of patients underwent isotretinoin retrial, with an estimated rate of 4.3 per 100 persons. The median time to a second isotretinoin course was 2.8 months, and it included a maximum daily dose of 0.82 mg/kg/d and a cumulative dose of 52.6 mg/kg for 2.3 months.
Among the 22.2% of patients who received a second isotretinoin course of four months or longer, 26.7% of patients exhibited a retrial at least six months after completing the initial course. Multivariable modeling revealed that female sex, age, and cumulative dosage were associated with reduced isotretinoin retrial rates.
Stratified analyses indicated that female sex was significantly associated with reduced isotretinoin retrial in both adolescents and adults. A higher cumulative dosage was associated with reduced acne relapse rates. Patients with conventional treatment and maximum daily doses of isotretinoin exhibited lower rates of acne relapse than those with low maximum daily doses.
Conclusions
The study findings indicate that a daily isotretinoin dose was not associated with a significant decrease in acne relapse risks or isotretinoin retrial rates among those with conventional and high cumulative dosages. However, a higher cumulative dosage of isotretinoin may potentially reduce the risk of acne relapse and isotretinoin retrial rates.
In the future, more research is needed to formulate optimized strategies to prevent acne relapse among high-risk individuals.
