Weinstock of the Providence (R.I.) VA Medical Center, and his associates in the VATTC trial conducted a post hoc analysis of the mortality data and confirmed an association with mortality--but no definitive causal links.
Until further evidence emerges to definitively establish the safety or harmfulness of the treatment, physicians should "at a minimum" discuss the VATTC results with their patients who use tretinoin cream--particularly with elderly men, who composed the bulk of the study population.
"This dialogue should include that the results of the VATTC may have been due to chance, but also that the outcome of death was not initially anticipated," Dr.
"The biological implausibility, lack of specificity of causes of death, inconsistency with previous experience, weakness of other supportive evidence in our data and weak statistical signal cast doubt on a potential causal association of topical tretinoin with death in the VATTC
Trial," the authors write.