F. Wessels et al., The cost-effectiveness of isotretinoin in the treatment of acne - Part 1. A meta-analysis of effectiveness literature, S AFR MED J, 89(7), 1999, pp. 780-784
Objectives. This paper reports the results of a meta-analysis of isotretino
in treatment in moderate to severe acne. It forms part of a comprehensive i
nvestigation into the cost-effective treatment of acne in South Africa and
as such establishes the clinical foundation for an economic model of acne m
anagement. This foundation includes an evaluation of the daily dosages, tre
atment durations, success rates, clinical effectiveness and relapse rates r
eported in published trials since 1981.
Methodology. A predetermined protocol for the study established the scope,
appropriate inclusion and exclusion criteria for peer-reviewed data, and th
e statistical rigour that would be applied to the selected data. Following
an extensive literature search, data reflecting the effectiveness of isotre
tinoin were extracted, statistically assessed, described and reported. The
combinability of the data was confirmed using analyses of variance and chi-
square tests, as applicable.
Results. Isotretinoin consistently proved to be a highly effective agent in
the treatment of moderate to severe acne vulgaris. The response rate deter
mined by the meta-analysis indicated a clinical cure in 84.22% to 86.71% of
patients treated. From the data considered, the average treatment duration
was calculated to be 17.9 weeks (4 months). The relapse rate was low (21.4
5%) and dose-dependent. Optimal results were achieved by treating patients
with a daily dose of 1 mg/kg and treating to a target cumulative dose of 12
0 mg/kg over the treatment duration.
Conclusion. The results of this meta-analysis support the continued use of
isotretinoin in the treatment of acne. The results are important in the fie
ld of pharmaceutical benefit management where they will assist in the optim
al management of this health condition. The results will be used to develop
a pharmaco-economic model to evaluate the various treatment regimens used
for acne in South Africa.