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    Isotretinoin’s discovery and development

    Expert discusses pearls gleaned from initial clinical observations

     

    More data

    Now that we actually have some data from the iPLEDGE experience, we are able to look at almost 30,000 patients with at least a one-year follow-up. Hopefully we can get the funding for the two- and three-year follow-up, because I think that will be even more interesting.

    READ: Teledermatology helps patients help themselves

    But clearly with a one-year follow-up, if you treat (the) very young, like 10- and 11-year-olds, their relapse rate (defined as return of acne requiring retreatment with isotretinoin — a clear endpoint for relapse) was 37%. In 12- to 14-year-olds, the relapse rate was in the 20% range, and about 12-13% in 15-17-year-olds.  In those ages 18 and older, you get the percentage that has been seen with most studies somewhere in the 8-12% range.[4]  In the original studies, most of the patients were older teenagers and those groups had very high rates of remaining clear. Of the subsequent studies that have been done looking at dosing really, as far as I’m concerned, aren’t very useful until they are stratified by age.

    My thinking is that this difference in lasting effects in older patients revolves around what happens to make acne go away? Before we had Accutane, people eventually got better. There are things that happen in the skin and eventually the disease goes away. I’m actually old enough to have treated people with X-ray. X-ray works quite well, it induces apoptosis of sebocytes, (as) we would say today. In the old days, we (said) it shut down the sebaceous gland, and even though there was regeneration, most of the time acne did not return. The reason is, almost everybody who got treated with X-ray, by definition, had been under treatment for a long time.

    I am very much opposed to pushing the high dose in the search for the holy grail of a cure.

    Elaine Siegfried, M.D.
    Elaine Siegfried, M.D., is professor of pediatrics and dermatology, Saint Louis University Health Sciences Center, St. Louis, Mo. She ...

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