Advanced colorectal neoplasia chemoprevention strategies assessed
medwireNews: Non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) are the most effective agents for preventing the development of advanced metachronous neoplasia in the short term among patients with previously resected neoplasia, but come with a high risk for serious adverse events.
As such, the researchers who conducted the network meta-analysis propose that non-aspirin NSAIDs, such as celecoxib and sulindac, “might be favorable only in individuals with previous high risk neoplasia.”
The analysis included 14 randomized controlled trials comprising 12,234 patients and showed that non-aspirin NSAIDs were ranked highest for efficacy and low-dose aspirin was second, reducing the risk for advanced metachronous neoplasia during a 3–5 year period by 63% and 29%, respectively.
But low-dose aspirin had the most favorable safety profile, reducing the serious adverse event risk by 22% versus placebo, whereas non-aspirin NSAIDs were ranked low for safety, increasing the risk by 23%.
Taken together, the data suggest that low-dose aspirin (≤160 mg/day) may be favorable for all patients with previous neoplasia, regardless of risk status, the team comments in The BMJ.
Siddharth Singh (University of California San Diego, La Jolla, USA) and co-investigators could not evaluate the efficacy for preventing colorectal cancer, but they say: “Advanced neoplasia, is [a] strong predictor of future colorectal cancer, and prevention of advanced metachronous neoplasia will therefore probably result in a reduced incidence of colorectal cancer.”
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