Is Isotretinoin safe to start in IBD patients?AbstractBACKGROUND & AIMS:Vitamin A is considered an anti-inflammatory fat-soluble vitamin. Current clinical evidence is lacking for the anti-inflammatory and immunomodulatory role of Vitamin A, specifically Isotretinoin (a systemic retinoid most efficaciously used in severe inflammatory acne) in Inflammatory Bowel Disease (IBD). Clinical evidence based on two large meta-analyses, have reliably debunked the anecdotal evidence of Isotretinoin’s association to IBD. 1,2 Additionally, experimental evidence in animal models have demonstrated anti-inflammatory outcomes with very little unfavorable gastrointestinal effects when treated with systemic retinoids. 3 Despite this, clinicians today remain overly cautious in using Isotretinoin in IBD patients which stems from a history of irrational litigations. 4Given Isotretinoin’s anti-phlogistic track record, we propose that it will demonstrate a similar effect on Inflammatory Bowel Disease and moreover, clinicians can feel confident and motivated to start Isotretinoin in this group of patients. METHODS:We used Cooper University Hospital’s EPIC database to performed a retrospective chart analysis of patients between 2005 and 2017 diagnosed with either Ulcerative colitis, Crohn’s Disease, or Indeterminate Colitis and Acne. We compared those who used Isotretinoin and those who did not. Of those patients treated with Isotretinoin, we studied only the patients that carried IBD diagnosis and were subsequently started on Isotretinoin treatment. RESULTS: Our search yielded 44 patients of which 24 matched our inclusion criteria of IBD (Crohn’s Disease, Ulcerative Colitis, or Indeterminate Colitis) and Acne diagnoses. Of the 24 patients, 4 were treated with Isotretinoin after being diagnosed with IBD while 20 were not. Chi Square analysis yielded a P-value of 0.037 for remission rate after Isotretinoin treatment compared to non-Isotretinoin group. Clinical remission data were obtained from the most recent Gastroenterology visits. The Isotretinoin group was composed of 50% males versus 25% in the non-Isotretinoin group. 100% of Isotretinoin group were diagnosed with Ulcerative Colitis compared to 65% in the non-Isotretinoin group. Demographic data in the Isotretinoin group consisted of 75% Caucasians, 25% Indian(Asian) Americans, and 0% African Americans compared to 75%, 5%, and 20% in the non-Isotretinoin group, respectively. CONCLUSIONS:In patients diagnosed with IBD, starting Isotretinoin for the treatment of Acne appeared to be safe. Further, patients treated with Isotretinoin were in clinical remission indicating that Isotretinoin may have an anti-inflammatory or immunomodulatory role in IBD. These findings may have clinical relevance to Gastroenterologists and/or Dermatologists when starting IBD patients on Isotretinoin. A larger sample size and prospective studies will need to be conducted to further support these outcomes.