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Topical tretinoin therapy and all-cause mortality
Martin A Weinstock1, Stephen F Bingham, Robert A Lew
1Dermatoepidemiology Unit, VA Medical Center, 111D, 830 Chalkstone Ave, Providence, RI 02908, USA. maw@brown.edu
Archives of Dermatology
|January 21, 2009
Summary
Topical tretinoin cream showed an association with increased all-cause mortality in a trial initially focused on skin cancer prevention. Further research is needed to understand this link between retinoid therapy and mortality risk.
Area of Science:
- Dermatology
- Oncology
- Clinical Trials
Background:
- Retinoids, like tretinoin, are used for skin conditions and have shown potential in cancer chemoprevention.
- Systemic retinoids have been linked to increased mortality in smokers.
- The Veterans Affairs Topical Tretinoin Chemoprevention Trial (VATTC) investigated topical tretinoin's effect on keratinocyte carcinoma risk.
Purpose of the Study:
- To evaluate the association between topical tretinoin and all-cause mortality.
- To assess the safety of topical tretinoin in a chemoprevention trial.
Main Methods:
- A blinded, randomized chemoprevention trial involving 1131 veterans.
- Participants received either 0.1% tretinoin cream or a vehicle control applied twice daily.
- Follow-up ranged from 2 to 6 years, with death as an unplanned outcome measure.
Main Results:
- The trial was halted early due to a higher number of deaths in the tretinoin group.
- Post hoc analysis revealed imbalances in age, comorbidity, and smoking status.
- Even after adjustment for these factors, a statistically significant association between tretinoin and mortality persisted.
Conclusions:
- An association between topical tretinoin therapy and increased all-cause mortality was observed.
- A causal link is not inferred, as current evidence suggests it is unlikely.
- The findings highlight the importance of monitoring mortality in chemoprevention trials.
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