Isotretinoin Use and Celiac Disease: A Population-Based Cross-Sectional Study
- Benjamin LebwohlAffiliated withCeliac Disease Center, Department of Medicine, Columbia University College of Physicians and SurgeonsDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet
- , Anders SundströmAffiliated withClinical Epidemiology Unit, Karolinska Institutet
- , Bana JabriAffiliated withCeliac Disease Center, University of Chicago
- , Sonia S. KupferAffiliated withCeliac Disease Center, University of Chicago
- , Peter H. R. GreenAffiliated withCeliac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons
- , Jonas F. LudvigssonAffiliated withDepartment of Medical Epidemiology and Biostatistics, Karolinska InstitutetDepartment of Paediatrics, Örebro University Hospital Email author
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Background and aim
Isotretinoin, a vitamin A analogue, can promote a pro-inflammatory milieu in the small intestine in response to dietary antigens. We hypothesized that oral isotretinoin exposure would increase the risk of celiac disease (CD).
We contacted all 28 pathology departments in Sweden, and through biopsy reports identified 26,739 individuals with CD. We then compared the prevalence of ever using oral isotretinoin to the prevalence in 134,277 matched controls through conditional logistic regression. Data on isotretinoin exposure were obtained from the national Swedish Prescribed Drug Registry. As the only indication for isotretinoin use in Sweden is acne, we also examined its relationship to CD. Data on acne were obtained from the Swedish Patient Registry.
Ninety-three individuals with CD (0.35 %) and 378 matched controls (0.28 %) had a prescription of isotretinoin. This corresponded to an odds ratio (OR) of 1.22 [95 % confidence interval (CI) 0.97–1.54]. Risk estimates were similar in men and women, and when we restricted our data to individuals diagnosed after the start of the Prescribed Drug Registry. Restricting our analyses to individuals diagnosed aged 12–45 years did not influence the risk estimates (OR 1.38, 95 % CI 0.97–1.97). Meanwhile, having a diagnosis of acne was positively associated with CD (OR 1.34, 95 % CI 1.20–1.51).
This study found no association between isotretinoin use and CD, but a small excess risk of CD in patients with a diagnosis of acne.
- Isotretinoin Use and Celiac Disease: A Population-Based Cross-Sectional Study
American Journal of Clinical Dermatology
Volume 15, Issue 6 , pp 537-542
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- 1. Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
- 2. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- 3. Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
- 4. Celiac Disease Center, University of Chicago, Chicago, IL, USA
- 5. Department of Paediatrics, Örebro University Hospital, Örebro, Sweden