Lai Jenny, Barbieri John S
Harvard Medical School, Boston, Massachusetts.
Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.
JAMA Dermatol. 2025 Apr 1;161(4):367-374. doi: 10.1001/jamadermatol.2024.5416.
Isotretinoin is the only medical acne treatment capable of inducing acne remission; however, some patients experience acne relapse and require retrials of isotretinoin. There is a need to understand who is most at risk and how daily dose and cumulative dosage can influence outcomes.
To assess rates of acne relapse and isotretinoin retrial and to identify associated factors among patients with acne who received an isotretinoin treatment course.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the MarketScan commercial claims database from January 1, 2017, to December 31, 2020, to identify patients with acne who were 12 years or older and had received isotretinoin for 4 months or longer, with at least 1 year of continuous enrollment after completion of isotretinoin. Data analyses were performed from June 30, 2024, to August 1, 2024.
Multivariable Cox proportional hazards regression was used to quantify associations of patient demographic and treatment characteristics with acne relapse and isotretinoin retrial.
A total of 19 907 patients (mean [SD] age, 20.6 [7.8] years; 10 504 females [52.8%]) were included, among whom 4482 (22.5%) had acne relapse and 1639 (8.2%) had isotretinoin retrial. Female sex (hazard ratio [HR], 1.43; 95% CI, 1.35-1.52) was significantly associated with increased rates of acne relapse, and isotretinoin cumulative dosage (mg/kg) was associated with a decreased rate of acne relapse (HR, 0.996; 95% CI, 0.995-0.997). Furthermore, daily dose was not associated with decreased risk of acne relapse or isotretinoin retrial among those with conventional and high cumulative dosages. Female sex (HR, 0.68; 95% CI, 0.62-0.76) and isotretinoin cumulative dosage (HR, 0.99; 95% CI, 0.98-0.99) were associated with decreased rates of isotretinoin retrial. Stratification by cumulative dosage indicated that higher cumulative dosage was associated with decreased rates of retrial among patients with low (<120 mg/kg) and conventional (120-220 mg/kg), but not high (>220 mg/kg) cumulative dosage. Maximum daily dose (mg/kg/d) was not negatively associated with acne relapse or isotretinoin retrial in patients with cumulative dosage of 120 mg/kg or more.
The findings of this cohort study suggest that higher cumulative dosage may potentially reduce risk of acne relapse and isotretinoin retrial. Furthermore, daily dose was not associated with decreased risk of the outcomes for conventional and high cumulative dosage; therefore, daily dosing could be individualized to patient goals and preferences.
异维A酸是唯一能够诱导痤疮缓解的药物治疗方法；然而，一些患者会出现痤疮复发，需要再次试用异维A酸。有必要了解谁的风险最高，以及每日剂量和累积剂量如何影响治疗结果。
评估痤疮复发率和异维A酸再次试用率，并确定接受异维A酸治疗疗程的痤疮患者中的相关因素。
设计、设置和参与者：这项队列研究使用了2017年1月1日至2020年12月31日MarketScan商业索赔数据库中的数据，以识别年龄在12岁及以上、接受异维A酸治疗4个月或更长时间、异维A酸治疗完成后连续登记至少1年的痤疮患者。数据分析于2024年6月30日至2024年8月1日进行。
使用多变量Cox比例风险回归来量化患者人口统计学和治疗特征与痤疮复发和异维A酸再次试用之间的关联。
共纳入19907例患者（平均[标准差]年龄，20.6[7.8]岁；10504例女性[52.8%]），其中4482例（22.5%）出现痤疮复发，1639例（8.2%）再次试用异维A酸。女性（风险比[HR]，1.43；95%置信区间，1.35-1.52）与痤疮复发率增加显著相关，而异维A酸累积剂量（mg/kg）与痤疮复发率降低相关（HR，0.996；95%置信区间，0.995-0.997）。此外，对于常规和高累积剂量的患者，每日剂量与痤疮复发风险降低或异维A酸再次试用无关。女性（HR，0.68；95%置信区间，0.62-0.76）和异维A酸累积剂量（HR，0.99；95%置信区间，0.98-0.99）与异维A酸再次试用率降低相关。按累积剂量分层表明，较高的累积剂量与低（<120 mg/kg）和常规（120-220 mg/kg）累积剂量患者的再次试用率降低相关，但与高（>220 mg/kg）累积剂量患者无关。累积剂量为120 mg/kg或更高的患者，最大每日剂量（mg/kg/d）与痤疮复发或异维A酸再次试用无负相关。
这项队列研究的结果表明，较高的累积剂量可能会降低痤疮复发和异维A酸再次试用的风险。此外，对于常规和高累积剂量，每日剂量与降低结局风险无关；因此，每日给药可以根据患者的目标和偏好进行个体化调整。
