A randomized trial of the efficacy of a new micronized formulation versus a standard formulation of isotretinoin in patients with severe recalcitrant nodular acne

BACKGROUND

Isotretinoin is very frequently the drug of choice for the management of severe recalcitrant nodular acne. Recently, a new micronized and more bioavailable formulation of isotretinoin has been developed that permits once-daily administration in lower doses than usually used with standard isotretinoin (Accutane), regardless of whether it is taken with or without food.

OBJECTIVE

Our purpose was to determine whether micronized isotretinoin and standard isotretinoin are clinically equivalent.

METHODS

In this multicenter, double-blind, double-dummy study, 600 patients with severe recalcitrant nodular acne were treated with either 0.4 mg/kg of micronized isotretinoin once daily without food (n = 300) or 1.0 mg/kg per day of standard isotretinoin in two divided doses with food (n = 300). Lesion counts were monitored over 20 weeks.

RESULTS

Both treatment groups in this well-controlled clinical trial experienced an equivalent reduction in the number of total nodules (facial plus truncal). In addition, an equivalent proportion of patients achieved 90% clearance of the total number of nodules. Both formulations had similar results for other efficacy variables.

CONCLUSION

Once-daily use of the micronized and more bioavailable formulation of isotretinoin under fasted conditions is clinically equivalent to the standard twice-daily formulation under fed conditions in the treatment of severe recalcitrant nodular acne.

Safety of a new micronized formulation of isotretinoin in patients with severe recalcitrant nodular acne: A randomized trial comparing micronized isotretinoin with standard isotretinoin

BACKGROUND

Isotretinoin is a very effective drug for treating severe recalcitrant nodular acne. A new micronized formulation of isotretinoin has been shown to be clinically equivalent to standard isotretinoin with improved bioavailability and minimal food effect. The safety profile of the micronized formulation has not been described previously.

OBJECTIVE

The objective of this article is to report the incidence and intensity of adverse events found in a comparative, double-blind efficacy study that showed clinical equivalence of the new micronized formulation of isotretinoin and the standard isotretinoin formulation (Accutane).

METHODS

Six hundred patients with severe recalcitrant nodular acne were treated with micronized isotretinoin (n = 300) under fasted conditions or standard isotretinoin (n = 300) under fed conditions. One cohort received single daily doses of 0.4 mg/kg of micronized isotretinoin without food and the other cohort received 1.0 mg/kg per day of standard isotretinoin in two divided doses with food. Adverse events were monitored during 20 weeks of drug therapy.

RESULTS

The proportion of adverse events in most body systems was generally lower in patients receiving micronized isotretinoin than in those receiving standard isotretinoin.

CONCLUSION

Micronized isotretinoin appears to have a safety profile similar to that of standard isotretinoin and to carry a lower risk of mucocutaneous events and hypertriglyceridemia.

Clinical study: peristomal skin irritation in colostomy patients

A prospective, controlled, clinical study was conducted to evaluate the effect of skin barriers and adhesives on the incidence of peristomal skin irritation. Colostomy patients eligible to participate were randomly assigned one of two sets of 10 one-piece pouching systems. At mid-study, after using the first 10 pouches, patients were allocated 10 pouches from the alternate pouching system. Each pouching system was worn for a maximum of 24 hours. One-hundred twelve patients were enrolled in the study. At baseline, 8 percent of patients had some erythema. At the end of the study period, 26 percent of patients exhibited signs of skin irritation. Patients were significantly more likely to develop skin irritation following use of the Karaya-based barrier than following use of the pectin-based barrier product (Wilcoxon Rank Sum Test, p < 0.01). Similarly, the type of tape used to secure the pouching system significantly influenced the incidence of skin irritation. Analysis of the change in skin condition as it relates to all evaluated variables; i.e. pouching system, stoma shape, stoma size, stoma length and irrigation, showed that only the type of product used was significantly associated with a change in skin condition. This is the first report of a controlled clinical study to evaluate the effect of pouching systems and patient/stoma variables on skin integrity in colostomy patients. These findings confirm that skin irritation can be a considerable problem, even in patients who use irrigation techniques.(ABSTRACT TRUNCATED AT 250 WORDS)

HP, GC and PI polymorphisms in sixteen central Indian tribal populations

HP, GC and PI polymorphisms have been typed on 16 Central Indian tribal populations with a total of 1658 individuals. The distribution of allele frequencies shows a statistically highly significant heterogeneity, which may be caused by several microevolutionary factors, such as genetic drift, social and geographic isolation. Some new variants were observed in both the GC system (GC 2Cmah) and in the PI system (PI Yori). The PI variants are more frequent and are found in most of the 16 populations under study whereas the GC variants are rather infrequent and restricted to only three populations.

Investigations on the variability of blood group polymorphisms among sixteen tribal populations from Orissa, Madhya Pradesh and Maharashtra, India

Sixteen tribal populations from Orissa, Madhya Pradesh and Maharashtra have been typed for the polymorphic blood group systems A1A2B0, MNSs, Rhesus, Kell, Duffy and Diego. The heterogeneity in the distribution of haplotype and allele frequencies, respectively, is partly considerable. It is supposed that this is due to the operation of several microevolutionary factors, such as genetic drift, social and geographic isolation and gene flow. This is discussed in detail.

The use of single-channel compression for the improvement of speech intelligibility

In this study, speech perception with commercially available linear and single-channel input- and output-dependent compression aids was investigated. Although compression has been introduced as a method of limiting the maximum output, theoretically expectations have been raised that a gain in speech intelligibility could also be obtained by a better use of the reduced dynamic range of the patient. It turned out that there was no significant difference in speech reception thresholds obtained both in quiet and in noise between the aids used for a group of 12 hearing-impaired hearing-aid users as a whole, or for different subgroups thereof.