Department of Pharmacy, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
Department of Medical Education, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
Am J Clin Dermatol. 2023 Sep;24(5):721-730. doi: 10.1007/s40257-023-00765-9. Epub 2023 Apr 3.
Cases of inflammatory bowel disease (IBD) following isotretinoin use have been reported previously, but whether isotretinoin exposure is associated with IBD has been unclear.
The aim was to evaluate whether isotretinoin use is associated with IBD.
We performed a systematic review and searched MEDLINE, Embase, and CENTRAL databases from inception to January 27, 2023 for relevant case-control and cohort studies. Our outcome was the pooled odds ratio (OR) for IBD and its two subtypes (Crohn disease and ulcerative colitis) in relation to isotretinoin exposure. We conducted a random-effects model meta-analysis and a sensitivity analysis by excluding low-quality studies. A subgroup analysis was undertaken by including studies considering antibiotic use. A trial sequential analysis (TSA) was performed to test the robustness of the conclusiveness of our results.
We included eight studies (four case-control and four cohort studies) with a total of 2,522,422 participants. The meta-analysis found no increased odds for IBD among patients receiving isotretinoin (OR 1.01; 95% confidence interval [CI] 0.80-1.27). Nor did the meta-analysis find increased odds for either Crohn disease (OR 0.87; 95% CI 0.65-1.15) or ulcerative colitis (OR 1.27; 95% CI 0.94-1.73) associated with isotretinoin exposure. The sensitivity and subgroup analyses produced similar results. In TSA, the Z-curve reached the futility boundaries when using relative risk reduction thresholds ranging from 5% to 15%.
This meta-analysis with TSA found no evidence of an association of isotretinoin use with IBD. Isotretinoin should not be withheld because of unnecessary concerns for the development of IBD.
CRD42022298886.
先前已有报道称，使用异维 A 酸后会出现炎症性肠病（IBD）病例，但异维 A 酸暴露是否与 IBD 相关尚不清楚。
评估异维 A 酸使用是否与 IBD 相关。
我们进行了一项系统评价，检索了 MEDLINE、Embase 和 CENTRAL 数据库，检索时间从建库至 2023 年 1 月 27 日，以获取相关的病例对照和队列研究。我们的结局是异维 A 酸暴露与 IBD 及其两个亚型（克罗恩病和溃疡性结肠炎）相关的汇总比值比（OR）。我们采用随机效应模型进行荟萃分析，并通过排除低质量研究进行敏感性分析。还进行了亚组分析，纳入了考虑抗生素使用的研究。采用试验序贯分析（TSA）来检验我们结果结论的稳健性。
我们纳入了 8 项研究（4 项病例对照研究和 4 项队列研究），共计 2522422 名参与者。荟萃分析发现，接受异维 A 酸治疗的患者发生 IBD 的几率没有增加（OR 1.01；95%置信区间 [CI] 0.80-1.27）。异维 A 酸暴露也与克罗恩病（OR 0.87；95% CI 0.65-1.15）或溃疡性结肠炎（OR 1.27；95% CI 0.94-1.73）的发生几率增加无关。敏感性和亚组分析得出了相似的结果。在 TSA 中，当使用从 5%到 15%不等的相对风险降低阈值时，Z 曲线达到了无效边界。
这项荟萃分析结合 TSA 未发现异维 A 酸使用与 IBD 之间存在关联的证据。不应该因为不必要地担心发生 IBD 而拒绝使用异维 A 酸。
PROSPERO 注册号：CRD42022298886。
