Increased Mortality Linked to Topical Retinoid Usage

Rise in mortality among individuals receiving topical tretinoin cream causes discontinuation of study

25 jan 2009-- Topical tretinoin, a frequently prescribed retinoid cream, is associated with increased all-cause mortality, according to study results published in the January issue of the Archives of Dermatology.

Martin A. Weinstock, MD, PhD, of the VA Medical Center in Providence, RI, and colleagues initiated the Veterans Affairs Topical Tretinoin Chemoprevention (VATTC) study, a randomized chemoprevention trial designed to test whether topical tretinoin could reduce the risk of keratinocyte cancers. A total of 1,131 veterans (mean age 71 years) were randomized to receive twice-daily application of either topical tretinoin cream (0.1 percent) or a vehicle control.

An excessive number of deaths in the tretinoin cream treatment arm led to a premature halt of the VATTC study. The excess deaths in the intervention group versus the control group (82 versus 53) were determined to be statistically significant. A post hoc analysis found age, presence of comorbidities, and smoking were all important predictors of mortality. No specific cause of death was associated with tretinoin use.

"Debate will continue regarding whether the association between topical tretinoin and death found in the VATTC resulted from chance or a real biological effect," the authors of an accompanying editorial write, adding practitioners "may wish to discuss the results of the VATTC with all patients using topical tretinoin."

Several of the study authors report financial relationships with the pharmaceutical industry. OrthoNeutrogena, a division of Ortho-McNeil Pharmaceutical Inc., provided the tretinoin and vehicle creams for the study.

Abstract
Full Text (subscription or payment may be required)
Editorial