ISOTRETINOIN is a transformative treatment for acne, offering the potential for lasting remission. Despite its efficacy, some patients experience relapse and require retreatment, necessitating a deeper understanding of factors influencing outcomes.
A recent cohort study using data from the MarketScan commercial claims database (2017–2020) examined acne relapse and isotretinoin retrial among 19,907 patients aged 12 years or older. These individuals had undergone at least four months of isotretinoin treatment and maintained continuous health coverage for a year following completion.
The study revealed that 22.5% of patients experienced acne relapse, and 8.2% required isotretinoin retrial. Key findings highlighted that female patients were more likely to relapse (hazard ratio [HR], 1.43) but less likely to require retrial (HR, 0.68). Crucially, higher cumulative dosages of isotretinoin were associated with reduced relapse risk (HR, 0.996) and retrial rates (HR, 0.99). This effect was evident among patients receiving low to conventional cumulative dosages (<120 mg/kg and 120–220 mg/kg), but not in those exceeding 220 mg/kg.
Interestingly, the study found no significant link between daily dosage and reduced risk of relapse or retrial for patients with conventional or high cumulative dosages. This suggests that daily dosing could be tailored to individual preferences and treatment goals without compromising long-term outcomes. These insights reinforce the importance of optimising cumulative dosage as a strategy to minimise relapse risk while allowing for flexibility in daily dosing regimens.
This research shows the necessity of personalised treatment plans for patients on isotretinoin. By focusing on achieving an adequate cumulative dosage and aligning daily dosing with patient needs, clinicians can enhance treatment outcomes while supporting patient comfort and adherence. As isotretinoin remains the only medical therapy capable of inducing acne remission, these findings offer valuable guidance for improving long-term success in acne management.
Katie Wright, EMJ
Reference
Lai J, Barbieri JS. Acne relapse and isotretinoin retrial in patients with acne. JAMA Dermatol. 2025;DOI:10.1001/jamadermatol.2024.5416.
