Isotretinoin and intestinal inflammation: what gastroenterologists need to know
Bibliographic record
Abstract
A possible aetiological role in the development or exacerbation of inflammatory bowel disease (IBD) has been suggested for a small number of drugs, including antibiotics,1 non-steroidal anti-inflammatory drugs (NSAIDs)2 and, more contentiously, oral contraceptive pills.3 Intriguing and less appreciated is the potential association of IBD with the use of the vitamin A analogue isotretinoin (13- cis -retinoic acid) which is widely prescribed in the treatment of severe acne. A small number of case reports have reported the development of IBD whilst receiving isotretinoin therapy.4–11 A review of adverse events reported to the United States Federal Drug Administration’s (FDA) Medwatch scheme over a 5 year period (1997–2002) revealed 85 cases of IBD, of which the causal association with isotretinoin was considered probable or highly probable in 73% of cases.12 It has been questioned whether this represents a true aetiological link, with the biggest confounder being the overlap in the peak age of the onset of IBD with the age group most commonly prescribed isotretinoin.13 Despite this there is biological plausibility in why such an association may exist. Retinoids have been shown to exhibit diverse effects on epithelial cell turnover, as well as glycoprotein and cytokine synthesis. More recently, advances in our understanding of the immunology of the gut have shown a fundamental role for retinoids in the regulation of the intestinal mucosal immune response. Here we discuss the literature on the association of isotretinoin therapy with intestinal inflammation and IBD, present an update of epidemiological and pharmaco-vigilance data, and highlight possible underlying mechanisms, based upon recent advances in mucosal immunology. IBD has not been noted in clinical trials of isotretinoin in the treatment of acne, but the exposure length and number of patients in trials may not have been sufficient. The association has …
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.009 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.001 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.001 | 0.003 |
| Scholarly communication | 0.004 | 0.015 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.012 | 0.011 |
| Insufficient payload (model declined to judge) | 0.011 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".