A systematic review of isotretinoin dosing in acne vulgaris

被引:3
作者
Daly, Aoife U. [1 ,2 ]
Goncalves, Rui Baptista [2 ]
Lau, Eva [2 ]
Bowers, Joanne [2 ]
Hussaini, Naayema [3 ]
Charalambides, Maria [4 ]
Coumbe, Jack [5 ]
Flohr, Carsten [6 ]
Layton, Alison M. [2 ]
机构
[1] Queens Univ Belfast, Sch Med Dent & Biomed Sci, Univ Rd, Belfast BT7 1NN, Antrim, North Ireland
[2] Harrogate & Dist NHS Fdn Trust, Dermatol Dept, Harrogate, England
[3] Trinity Coll Dublin, Trinity Biomed Sci Inst, Sch Med, Dublin, Ireland
[4] Univ Birmingham, Birmingham Med Sch, Coll Med & Dent Sci, Birmingham, England
[5] Kings Coll London, Henriette Raphael House,Guys Campus, London, England
[6] Guys & St Thomas NHS Fdn Trust, St Johns Inst Dermatol, London, England
来源
JEADV CLINICAL PRACTICE | 2023年 / 2卷 / 03期
关键词
acne; acne vulgaris; isotretinoin; LOW-DOSE ISOTRETINOIN; ORAL ISOTRETINOIN; EFFICACY; INTERMITTENT; MODERATE; THERAPY; APOPTOSIS; REGIMENS; RELAPSE; MG;
D O I
10.1002/jvc2.154
中图分类号
R75 [皮肤病学与性病学];
学科分类号
100206 ;
摘要
How does low-dose oral isotretinoin compare with recommended and high-dose oral isotretinoin in terms of efficacy, adverse effect profile, duration of remission, economic profile and rate and severity of relapse? A systematic literature search of EMBASE, MEDLINE, PubMed and The Cochrane Library from 1983 to July 2022 was conducted to identify randomised control trials (RCTs), cohort studies and cross-sectional studies investigating the treatment of acne vulgaris with oral isotretinoin. This systematic review of the literature sought to explore and compare the use of different isotretinoin dosing regimens. Primary outcomes were efficacy, relapse, and safety profiles of oral isotretinoin of varying doses. Secondary outcomes included adverse events and economic considerations. The quality of studies, including risk of bias was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluations). A total of 32 studies were included. Severe acne responds better to conventional or high fixed daily doses of isotretinoin. In cases of mild to moderate acne, where oral isotretinoin was prescribed, clearance rates were comparable with low, conventional or high dosage regimens. Despite this, relapse was more frequent in those treated with a lower dose. The severity of mucocutaneous adverse effects worsens as the dose of isotretinoin is increased. Comparison between studies was challenging due to differing methods of assessment, outcome measures and duration of follow-up. This review highlights the need for an adequately powered RCT comparing low, conventional and high doses of oral isotretinoin to establish optimal dosing for treatment and prevention of relapse in acne vulgaris.
引用
收藏
页码:432 / 449
页数:18
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