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Current Drug Safety

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ISSN (Print): 1574-8863
ISSN (Online): 2212-3911

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Systematic Review Article

Low-Dose versus Conventional-dose Oral Isotretinoin Regimens: A Systematic Review on Randomized Controlled Comparative Studies of Different Regimens

Author(s): Lili Legiawati*, Alessa Fahira, Iqbal Taufiqqurrachman, Ghafur R. Arifin and Ucca R. Widitha

Volume 18, Issue 3, 2023

Published on: 16 September, 2022

Page: [297 - 306] Pages: 10

DOI: 10.2174/1574886317666220613162225

Price: $65

Abstract

Background: The effectiveness of Isotretinoin is superior compared to other acne therapies, particularly in reducing acne lesion counts. Concerns, however, arise relating to the most optimal dosage regimen with the best efficacy and lesser side effect.

Objective: We intend to review existing randomized controlled comparative studies of isotretinoin in different regimens.

Methods: PubMed, Cochrane, Scopus, and ScienceDirect were searched. The inclusion criteria is the RCT article. Full-text reading excluded articles that did not use GAGS as the method of measurement. Out of 921 articles that were electronically searched, 6 RCTs were extracted and summarized descriptively. After full-text reading, 4 RCTs were included. We then conducted risk of bias assessments for the selected studies using The Cochrane Risk of Bias Tool.

Results: Across all trials, low-dose regimens were preferable in all types of acne-owing to its similar efficacy to conventional dose but with fewer occurrence of side effects as well as better patients’ satisfaction and compliance. Furthermore, a continuous low-dose regimen had the best efficacy in comparison to other regimens of low-dose treatment.

Discussion: The limitations of our study include a slight difference in dosage between selected studies. Other limitations are that some studies did not explain the side effects and relapse rate thoroughly and did not state the compliance scoring method used.

Conclusion: This review recommends continuous low-dose treatment as the chosen regimen for acne vulgaris. However, further evaluation regarding relapse rate compared to the conventional dose is needed.

Keywords: Isotretinoin, acne vulgaris, dose, efficacy, safety, management

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[1]
Fox L, Csongradi C, Aucamp M, du Plessis J, Gerber M. Treatment modalities for acne. Molecules 2016; 21(8): 1063.
[http://dx.doi.org/10.3390/molecules21081063] [PMID: 27529209]
[2]
Hay RJ, Johns NE, Williams HC, et al. The global burden of skin disease in 2010: An analysis of the prevalence and impact of skin conditions. J Invest Dermatol 2014; 134(6): 1527-34.
[http://dx.doi.org/10.1038/jid.2013.446] [PMID: 24166134]
[3]
Davis SA, Narahari S, Feldman SR, Huang W, Pichardo-Geisinger RO, McMichael AJ. Top dermatologic conditions in patients of color: An analysis of nationally representative data. J Drugs Dermatol 2012; 11(4): 466-73.
[PMID: 22453583]
[4]
Yin NC, McMichael AJ. Acne in patients with skin of color: Practical management. Am J Clin Dermatol 2014; 15(1): 7-16.
[http://dx.doi.org/10.1007/s40257-013-0049-1] [PMID: 24190453]
[5]
Goh C, Cheng C, Agak G, et al. Acne Vulgaris. In: Kang S, Amagai M, Bruckner AL, Enk AH, Margolis DJ, McMichael AJ, Eds. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw-Hill 2019; pp. 1391-411.
[6]
Leyden JJ, Del Rosso JQ, Baum EW. The use of isotretinoin in the treatment of acne vulgaris: Clinical considerations and future directions. J Clin Aesthet Dermatol 2014; 7(2) (Suppl.): S3-S21.
[PMID: 24688620]
[7]
Brito MF, Sant’Anna IP, Galindo JC, Rosendo LH, Santos JB. Evaluation of clinical adverse effects and laboratory alterations in patients with acne vulgaris treated with oral isotretinoin. An Bras Dermatol 2010; 85(3): 331-7.
[http://dx.doi.org/10.1590/S0365-05962010000300006] [PMID: 20676466]
[8]
Doshi A, Zaheer A, Stiller MJ. A comparison of current acne grading systems and proposal of a novel system. Int J Dermatol 1997; 36(6): 416-8.
[http://dx.doi.org/10.1046/j.1365-4362.1997.00099.x] [PMID: 9248884]
[9]
Balaji A, Rashmi K, Devinder M. Scoring systems in acne vulgaris. Indian J Dermatol Venereol Leprol 2009.
[10]
Niazi S, Shehzad A. Comparison of efficacy of fixed low-dose regimens (daily vs alternate day) of oral isotretinoin in mild to moderate acne vulgaris. J Pak Assoc Dermatol 2016; 25: 291-7.
[11]
Boyraz N, Mustak PK. Comparison of the efficacies of intermittent and continuous low‐dose isotretinoin regimens in the treatment of moderate acne vulgarisJ Pak Assoc Dermatol 2013.
[12]
Lee JW, Yoo KH, Park KY, et al. Effectiveness of conventional, low-dose and intermittent oral isotretinoin in the treatment of acne: A randomized, controlled comparative study. Br J Dermatol 2011; 164(6): 1369-75.
[http://dx.doi.org/10.1111/j.1365-2133.2010.10152.x] [PMID: 21114478]
[13]
Faghihi G, Mokhtari F, Fard NM, Motamedi N, Hosseini SM. Comparing the efficacy of low dose and conventional dose of oral isotretinoin in treatment of moderate and severe acne vulgaris. J Res Pharm Pract 2017; 6(4): 233-8.
[http://dx.doi.org/10.4103/jrpp.JRPP_17_30] [PMID: 29417084]
[14]
Borghi A, Mantovani L, Minghetti S, Giari S, Virgili A, Bettoli V. Low-cumulative dose isotretinoin treatment in mild-to-moderate acne: Efficacy in achieving stable remission. J Eur Acad Dermatol Venereol 2011; 25(9): 1094-8.
[http://dx.doi.org/10.1111/j.1468-3083.2010.03933.x] [PMID: 21198947]
[15]
Agarwal US, Besarwal RK, Bhola K. Oral isotretinoin in different dose regimens for acne vulgaris: A randomized comparative trial. Indian J Dermatol Venereol Leprol 2011; 77(6): 688-94.
[http://dx.doi.org/10.4103/0378-6323.86482] [PMID: 22016276]
[16]
Ramli R, Malik AS, Hani AFM, Jamil A. Acne analysis, grading and computational assessment methods: An overview. Skin Res Technol 2012; 18(1): 1-14.
[http://dx.doi.org/10.1111/j.1600-0846.2011.00542.x] [PMID: 21605170]

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