title: Isotretinoin and risk for inflammatory bowel disease: a nested case-control study and meta-analysis of published and unpublished data.
abstract: OBJECTIVE
  To examine the association between isotretinoin and the risk for inflammatory bowel disease (IBD) among women of reproductive age.
  
  
  METHODS
  Nested case-control study and meta-analysis.
  
  
  METHODS
  A US health claims database.
  
  
  METHODS
  We formed a cohort of women aged 18 to 46 years who had received at least 1 oral contraceptive prescription from May 1, 2001, through December 31, 2009. The IBD cases were required to have 3 health care contacts with documentation of IBD or a single health care contact followed by use of a drug to treat IBD. Twenty controls were selected for each case using incidence-density sampling, matched on age and date of diagnosis.
  
  
  METHODS
  Risk ratios (RRs) were formed for incident cases of IBD associated with the use of isotretinoin. A subgroup analysis examined the risk for IBD among those diagnosed as having Crohn disease (CD) and ulcerative colitis (UC). A meta-analysis of published and unpublished studies assessing isotretinoin and IBD used a random-effects model to estimate a pooled RR.
  
  
  RESULTS
  In the case-control study, we identified 2159 IBD cases (1056 with UC and 1103 with CD) and matched them with 43 180 controls. Only 10 cases (0.46%) and 191 controls (0.44%) were exposed to isotretinoin. The adjusted RR for IBD was 0.99 (95% CI, 0.52-1.90). The RRs for UC and CD were 1.10 (95% CI, 0.44-2.70) and 0.91 (0.37-2.25), respectively. For the meta-analysis, the pooled RR for IBD for the 5 studies was 0.94 (95% CI, 0.65-1.36).
  
  
  CONCLUSIONS
  The results of this study do not suggest an increase in the risk for IBD, including UC or CD, with use of isotretinoin. Because inflammatory acne in children and adolescents carries a high psychological burden, clinicians should not be discouraged from prescribing this drug owing to a putative association with IBD.
authors: Therapeutic Evaluation Unit, Child and Family Research Institute of British Columbia, University of British Columbia, 950W28th Ave, Room A4-195, Vancouver, BC V5Z 4H4, Canada. metminan@popi.ubc.ca
authors: Mahyar
authors: M
authors: Etminan
authors: Steven T
authors: ST
authors: Bird
authors: Joseph A
authors: JA
authors: Delaney
authors: Brian
authors: B
authors: Bressler
authors: James M
authors: JM
authors: Brophy
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D003093:Colitis, Ulcerative / Q000139:chemically induced* / Q000453:epidemiology; D003424:Crohn Disease / Q000139:chemically induced* / Q000453:epidemiology; D016208:Databases, Factual; D003879:Dermatologic Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D015474:Isotretinoin / Q000009:adverse effects*; D008875:Middle Aged; D016017:Odds Ratio; D014481:United States; D055815:Young Adult
chemical_list: D003879:Dermatologic Agents; D015474:Isotretinoin