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Results: 4

1.
Figure 4

Figure 4. From: A causal association between Accutane and IBD has yet to be established.

Appearance of pyoderma faciale, an extraintestinal manifestation of inflammatory bowel disease that may mimic acne.
Reprinted with permission from Cutis. 2008;81:488-490. ©2008, Quadrant HealthCom Inc.(39)

Seth D. Crockett, et al. Am J Gastroenterol. ;104(10):2387-2393.
2.
Figure 3

Figure 3. From: A causal association between Accutane and IBD has yet to be established.

Diagram of a possible non-causal sequence of events leading to an observed temporal relationship between isotretinoin use and inflammatory bowel disease. Because of delays in the initial diagnosis of IBD, subclinical onset of disease may precede the initial prescription of isotretinoin. If isotretinoin is discontinued when IBD is initially diagnosed, and reintroduced when disease activity is quiescent, subsequent flares of disease typical of the natural history of IBD could be mistaken for effects of re-exposure to the drug.
IBD: inflammatory bowel disease

Seth D. Crockett, et al. Am J Gastroenterol. ;104(10):2387-2393.
3.
Figure 2

Figure 2. From: A causal association between Accutane and IBD has yet to be established.

Graph of the peak ages of isotretinoin prescriptions and incidence of Crohn’s disease demonstrating the normal temporal sequence of development of IBD in Accutane users, and evidence for confounding based on age as an explanation for the temporal association between drug and disease.
Figure based on data from Loftus et al., Gastroenterology 1998;114(6) 1161-8 (17) and Wysowski et al., J Am Acad Dermatol 2002; 46(4) 505-9 (19)

Seth D. Crockett, et al. Am J Gastroenterol. ;104(10):2387-2393.
4.
Figure 1

Figure 1. From: A causal association between Accutane and IBD has yet to be established.

A hypothetical cohort study of the entire US population is represented in this model 2×2 table. The time period at risk is 1 year. Equal rates of IBD in both exposed persons (“received isotretinoin”) and unexposed persons (“No isotretinoin”) would correspond to an incidence rate ratio of 1 (i.e. no causation). We made assumptions about the annual incidence of IBD, the number of persons exposed to isotretinoin per year, and the size of the US population using the best available data. We then calculated the expected number of new cases of IBD per year in those taking isotretinoin assuming no causation (calculation below). The number of cases per year in those taking isotretinoin would have to be greater than 59 in order to support a causal association.
Where x = expected cases with exposure


IBD: inflammatory bowel disease; py: person years

Seth D. Crockett, et al. Am J Gastroenterol. ;104(10):2387-2393.

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