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Oral isotretinoin for acne

Citation: Costa CS, Bagatin E, Martimbianco ALC, et al. Oral isotretinoin for acne. Cochrane Database Syst Rev. 2018 Nov 24;11:CD009435. doi: 10.1002/14651858.CD009435.pub2. (Review) PMID: 30484286

OBJECTIVES: To assess efficacy and safety of oral isotretinoin for acne vulgaris.

SELECTION CRITERIA: Randomised clinical trials (RCTs) of oral isotretinoin in participants with clinically diagnosed acne compared against placebo, any other systemic or topical active therapy, and itself in different formulation,doses, regimens, or course duration.

MAIN RESULTS: We included 31 RCTs, involving 3836 participants (12 to 55 years) with mild to severe acne. There were twice as many male participants as females.Most studies were undertaken in Asia, Europe, and North America. Pharmaceutical companies funded 12 included trials. All, except three studies, had high risk of bias in at least one domain.

AUTHORS‘ CONCLUSIONS: Evidence was low-quality for most assessed outcomes.We are unsure if isotretinoin improves acne severity compared with standard oral antibiotic and topical treatment when assessed by a decrease in total inflammatory lesion count, but it may slightly improve physician-assessed acne severity. Only one serious adverse event was reported in the isotretinoin group, which means we are uncertain of the risk of serious adverse effects; however, isotretinoin may result in more minor adverse effects.

Daily treatment may be more effective than treatment for one week each month. None of the studies in this comparison reported serious adverse effects, or measured improvement in acne severity assessed by physician’s global evaluation. We are uncertain if there is a difference in number of minor adverse effects, such as skin dryness, between doses/regimens. Evidence quality was lessened due to imprecision and attrition bias. Further studies should ensure clearly reported long- and short-term standardised assessment of improvement in total inflammatory lesion counts, participant-reported outcomes, and full safety accounts. Oral isotretinoin for acne that has not responded to oral antibiotics plus topical agents needs further assessment, as well as different dose/regimens of oral isotretinoin in acne of all severities.

Fazit ÄiW:

Das Review macht deutlich, dass die Evidenz sowohl für die Wirkung an sich als auch für die unterschiedlichen Dosisregimes schwach ist.
Andere Quellen berichten jedoch, dass 40% der Pat. nach der Therapie dauerhaft geheilt sind (JAMA Dermatol 2013, Br J Dermatology 2007).
Unsere Aufgabe als Hausarzt wäre es, Beratung und Aufklärung über Basispflege und Therapieoptionen vorzuhalten.

Fazit Regen:

Wir geben es in der Praxis eigentlich nicht. Die Indikation gestellt und verordnet wird es vom Dermatologen. Wir beraten die Patienten im Zweifelsfall.