Isotretinoin Use and Celiac Disease: A Population-Based Cross-Sectional Study
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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.
BL was funded by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Number UL1 TR000040. JFL was supported by grants from the Swedish Society of Medicine, the Swedish Research Council—Medicine (522-2A09-195), and the Swedish Celiac Society.
Dr. Lebwohl: The author declares that he has no conflict of interest. Dr. Sundström: The author declares that he has no conflict of interest. Dr. Jabri: The author declares that she has no conflict of interest. Dr. Kupfer: The author declares that she has no conflict of interest. Dr. Green: The author declares that he has no conflict of interest. Dr. Ludvigsson: The author declares that he has no conflict of interest.
Details of ethics approval
This project (2006/633-31/4) was approved by the Research Ethics Committee of the Karolinska Institute, Sweden, on June 14, 2006.
International Committee of Medical Journal Editors (ICMJE) criteria for authorship read and met: BL, AS, BJ, SSK, PG, and JFL. Agree with the manuscript’s results and conclusions: BL, AS, BJ, SSK, PG, and JFL. Designed the experiments/the study: BL and JFL. Collected data: JFL. Analyzed the data: BL. Wrote the first draft of the paper: BL and JFL. Contributed to study design, interpretation of data and writing: AS and PG. Interpretation of data; approved the final version of the manuscript: BL, AS, BJ, SSK, PG, and JFL. Responsible for data integrity: JFL. Obtained funding: JFL.
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