Weight Change in Isotretinoin Therapy

Summary: Isotretinoin has been used to treat severe acne since the early 1980s. The first pilot study, conducted by Gary Peck, demonstrated that dosing regimens of 0.1 mg/kg, 0.5 mg/kg, and 1.0 mg/kg all showed benefits when treating individuals with acne not otherwise treated by cyclic topical antibiotics. Since Peck’s pilot study, research has shown a positive correlation between the maximum dosage of isotretinoin received and the adverse events experienced by patients. Cumulative exposures below 120 mg/kg, show an earlier recurrence of acne vulgaris and an increased likelihood that the patient will require a repeat course of treatment. At cumulative exposures greater than 120 mg/kg, patients maintain stable remission over a year post-treatment. When patient therapy exceeds a threshold of greater than 150 mg/kg isotretinoin, patients are more likely to experience long-term side effects such as xeroderma, dry eye syndrome arthralgia, and eczema exacerbation. To limit such adverse events while still maximizing efficacy, optimal results are seen within a cumulative isotretinoin exposure range of *120-150 mg/kg. The current standard of care uses the patient’s starting weight to establish the duration of treatment. A retrospective cohort analysis was performed in which the starting and ending weights of isotretinoin patients, ages 13-21, were collected over a given 5-year period (+/- 5 years; 2015-2020) using the iPledge database for Augusta University attending physicians. This study seeks to evaluate if there are specific patient groups more likely to experience a significant change in weight necessitating an adjustment to isotretinoin therapy over time.