Efficacy and relapse rates of different Isotretinoin dosages in treating acne vulgaris: systematic review and proposed retrospective study

Abstract

Isotretinoin has been used over decades to treat moderate to severe acne vulgaris that is resistant to adequate courses of standard therapy with systemic antibacterials and topical therapy. However, the ideal dosing regime remains controversial. The relapse rates of different Isotretinoin dosages are unclear. A systematic review of clinical trials has been conducted to examine the optimum Isotretinoin regime to achieve complete acne clearance, with the lowest relapse rate.
Forty one journal articles were reviewed, comprising clinical trials only. This systematic review suggested that the studies were of greatly diverse designs especially in terms of the patient characteristics, Isotretinoin regimes and outcome measurements. Relapse rate was defined in several different ways. The clinical trials were found to have certain degree of risk of bias. Hence, it is difficult to produce any recommendation based on the existing evidences.
Varying Isotretinoin regimes have also been adopted locally at Glan Clwyd Hospital. A retrospective cohort study investigating the efficacy and relapse rates of different Isotretinoin dosages at the hospital was proposed. This retrospective study has received conditional favourable ethical opinion from Wales Research Ethics Committee (NRES), local Research and Development department (R&D) and Confidentiality Advisory Group (CAG). However, this study was not able to obtain a final approval from the Health Research Authority due to issues regarding potential equivalency of the Information Governance Toolkit and the Wales Caldicott Principles in Practice. It is the Department of Health policy for all bodies that process NHS patient information to provide security assurance through annual completion and publication of an Information Governance Toolkit. Betsi Cadwaladr University Health adopts Wales Caldicott Principles in Practice as its information governance policy instead of Information Governance Toolkit. This is currently being dealt with at a national level by NHS England and NHS Wales Informatics Service. These organisations are currently producing a Memorandum of Understanding to deal with these issues.

Date of Award	2016
Original language	English
Awarding Institution	Bangor University
Supervisor	Rachel Hallett (Supervisor)