A recent investigation conducted by researchers at Mass General Brigham focused on the frequency of acne recurrence following treatment with isotretinoin, the sole medical therapy recognized for achieving long-term remission of severe acne. The study also aimed to identify factors that may increase the likelihood of acne returning in patients. In the United States, isotretinoin is commonly known as Accutane, while it is referred to by different names in India. The findings of this research were published in JAMA Dermatology.

What the study found

The research revealed that approximately 20% of patients experienced a recurrence of acne that necessitated treatment with oral medications, including antibiotics, spironolactone, or an additional course of isotretinoin. Notably, this recurrence was more prevalent among female patients and those who had received lower cumulative dosages of the medication. However, the daily dosage did not serve as a predictor for acne recurrence.

More about the study

This cohort study encompassed 19,907 patients and determined that 22.5% experienced a relapse of acne, while 8.2% underwent a retrial of isotretinoin. The analysis indicated that cumulative dosage was significantly linked to reduced rates of both relapse and retrial (hazard ratio [HR], 0.99 for each); female patients were found to have a significantly higher rate of relapse (HR, 1.43) and a lower rate of retrial (HR, 0.68). Furthermore, daily dosage did not show a negative correlation with relapse or retrial among patients who had cumulative dosages of 120 mg/kg or greater.

The cohort study utilized data from the MarketScan commercial claims database, covering the period from January 1, 2017, to December 31, 2020. It identified patients aged 12 years and older who had received isotretinoin for a minimum of four months and maintained at least one year of continuous enrollment following the completion of their isotretinoin treatment. Data analyses were conducted between June 30, 2024, and August 1, 2024.

One of the researchers, John Barbierim, stated that the results indicate the potential for personalizing dosing regimens based on the goals and preferences of patients. As long as an adequate cumulative dose is achieved, both lower and higher daily dosing strategies seem to be effective. Given that side effects are closely linked to dosage, these findings can assist clinicians in collaborating with patients to determine the most suitable dose that balances risks and benefits.

Conclusions and relevance

The results of this study imply that a higher cumulative dosage may help decrease the likelihood of acne relapse and the need for isotretinoin retrial. Additionally, daily dosing did not correlate with a reduced risk of outcomes for either conventional or high cumulative dosages; thus, daily dosing can be tailored to align with patient goals and preferences.

If you are facing persistent severe acne despite ongoing medication, it is advisable to consult your dermatologist to eliminate any underlying issues and modify your treatment plan as necessary.

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