A new study from Mass General Brigham reveals that individualized dosing of isotretinoin, the gold standard treatment for severe acne, can maximize effectiveness while minimizing side effects. The research, published in JAMA Dermatology, suggests that both lower and higher daily doses can be effective as long as a sufficient cumulative dose is reached (220mg/kg). This finding empowers clinicians to tailor treatment plans to each patient's specific needs and preferences.
Isotretinoin, commonly known as Accutane, stands as the sole FDA-approved medical treatment capable of inducing long-term remission in severe acne. While remarkably effective, a subset of individuals experience acne recurrence following a treatment course. A recent study conducted by researchers at Mass General Brigham delved into the frequency of acne reappearance after isotretinoin and explored the factors that might predispose patients to its return.
The study revealed that approximately 1 in 5 patients experienced acne recurrence, necessitating treatment with an oral medication such as antibiotics, spironolactone, or another round of isotretinoin. This recurrence was more prevalent among female patients and those who had received lower cumulative dosages of isotretinoin. However, the researchers discovered that the daily dose of isotretinoin did not correlate with the likelihood of acne reappearance. Furthermore, the benefits of higher cumulative doses were not observed beyond 220mg/kg. These findings were published in the Journal of the American Medical Association Dermatology (JAMA Dermatology).The study's results lend support to the concept of individualizing dosing regimens based on patient goals and preferences. As long as a sufficient cumulative dose of isotretinoin is achieved, both lower and higher daily dose regimens appear to be equally effective. Given that side effects are highly dependent on the dose, these findings empower clinicians to collaborate with patients in selecting the optimal dose that effectively balances risks and benefits. John Barbieri, MD, MBA, from the Department of Dermatology and Director of the Advanced Acne Therapeutics Clinic at Brigham and Women's Hospital, elaborated on the study's significance. Utilizing data from MarketScan, this retrospective analysis encompassed patients with a history of acne who had undergone a course of isotretinoin treatment lasting at least four months and possessed at least one year of follow-up data. Out of the 19,907 patients analyzed, 35% received subsequent prescriptions for acne treatment, with 22.5% requiring oral medications, and 8.2% receiving a second course of isotretinoin. The study also highlighted that female patients faced a greater risk of acne recurrence, although they were less likely to require a second course of isotretinoin. The researchers determined that a higher cumulative isotretinoin dosage was associated with a reduced risk of acne recurrence, but this relationship plateaued at 220mg/kg
ISOTRETINOIN ACNE RECURRENCE DOSING REGIMENS TREATMENTS
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