Isotretinoin Exposure and Risk of Celiac Disease.
BACKGROUND
Isotretinoin (13-cis retinoic acid) is a metabolite of vitamin A and has anti-inflammatory and immunoregulatory effects; however, a recent publication by DePaolo et al. demonstrated that in the presence of IL-15, retinoic acid can act as an adjuvant and promote inflammation against dietary proteins.


OBJECTIVE
To evaluate the risk of overt and latent celiac disease (CD) among users of isotretinoin.


METHODS
Medical records of patients from 1995 to 2011 who had a mention of isotretinoin in their records (N = 8393) were searched for CD diagnosis using ICD-09CM codes. Isotretinoin exposure was compared across overt CD patients and their age- and gender-matched controls from the same pool. To evaluate the risk of latent CD with isotretinoin exposure, patients were overlapped with a community-based list of patients with waste serum samples that were tested for CD serology, excluding those with overt CD (2006-2011). Isotretinoin exposure was defined as the use of isotretinoin prior to CD diagnosis or serology.


RESULTS
Of 8393 patients, 25 had a confirmed CD diagnosis. Compared to matched controls (N = 75), isotretinoin exposure was not significantly different between overt CD patients versus controls (36% versus 39%, respectively; P = 0.712). Likewise, latent CD defined as positive serology was not statistically different between isotretinoin exposed (N = 506) versus non-exposed (N = 571) groups (1.8% versus 1.4%, respectively; P = 0.474).


CONCLUSIONS
There was no association between isotretinoin use and risk of either overt or latent CD.
Department of Dermatology, Mayo Clinic, Rochester, Minnesota, United States of America.
Shadi
S
Rashtak
Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States of America.
Shahryar
S
Khaleghi
Department of Dermatology, Mayo Clinic, Rochester, Minnesota, United States of America; Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States of America; Department of Immunology, Mayo Clinic, Rochester, Minnesota, United States of America.
Eric V
EV
Marietta
Department of Dermatology, Mayo Clinic, Rochester, Minnesota, United States of America.
Mark R
MR
Pittelkow
Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States of America.
Joseph J
JJ
Larson
Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States of America.
Brian D
BD
Lahr
Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States of America; Department of Immunology, Mayo Clinic, Rochester, Minnesota, United States of America.
Joseph A
JA
Murray
D000152:Acne Vulgaris / Q000188:drug therapy; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002446:Celiac Disease / Q000139:chemically induced* / Q000453:epidemiology*; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D019409:Interleukin-15 / Q000378:metabolism*; D015474:Isotretinoin / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012306:Risk; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D003879:Dermatologic Agents; C569274:IL15 protein, human; D019409:Interleukin-15; D015474:Isotretinoin