Aspirin Reduces Colorectal Adenoma Risk in High-Risk Patients: Presented at UEGW

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Title: Aspirin Reduces Colorectal Adenoma Risk in High-Risk Patients: Presented at UEGW
URL: http://www.pslgroup.com/dg/2313FE.htm
Doctor's Guide
October 22, 2008

By Judith Moser, MD

VIENNA, Austria -- October 22, 2006 -- Aspirin use reduces the risk of colorectal adenoma by 17% and of advanced adenoma by 28% in high-risk patients, according to a meta-analysis presented here at the 16th United European Gastroenterology Week (UEGW).

For the last 30 years, evidence has accumulated from observational and experimental research that aspirin has antineoplastic effects in the large bowel, said researcher Matthew J. Grainge, MD, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom.

Dr. Grainge and colleagues in the United States and France conducted their analysis to summarise the available data from secondary prevention trials, including randomised, controlled trials of aspirin treatment at any dose that treated patients for at least 1 year, he said during an oral session on October 22.

All patients had complete colonoscopies demonstrating no known bowel polyps and were assessed systematically for evidence of colorectal polyps after randomisation.

Detection of at least 1 colorectal adenoma during follow-up was defined as primary outcome. The secondary outcome was detection of advanced neoplasia.

The researchers identified 4 trials that fulfilled entry criteria with a total of more than 2,967 patients.

In 3 of the studies, patients had a recent history of colorectal adenomas. Patients in the fourth study had history of colorectal cancer. All studies used a standard aspirin dose of about 300 mg and included intervention periods of about 3 years.

In 35% of 2,698 patients at least 1 colorectal adenoma was detected during the follow-up period.

"Overall, aspirin-treated patients had a significantly lower risk by 17%," Dr. Grainge reported.

About 10% of all patients developed 1 or more advanced lesions.

According to Dr. Grainge, the effect of aspirin was more marked in this population, with patients randomised to aspirin experiencing a 28% risk reduction.

Analysis based on the dosage revealed no obvious differences between high-dose and low-dose aspirin.

Stratification of patients according to age, sex, body mass index, family history of colorectal cancer, and number of lifetime adenomas at baseline showed similar adenoma risk reductions consistent with the overall risk reduction across all subgroups.

In the subgroup with advanced adenoma, patients with a family history of colorectal cancer had a greater risk reduction when treated with aspirin (36% vs 12% in patients with no family history).

Rates of death, myocardial infarction, major haemorrhage, or invasive cancer were similar in the aspirin and placebo groups. Strokes occurred only in aspirin-treated patients (n = 12; P = .0034), but 11 of them were of thrombotic origin.

"We believe that we can add prevention of colorectal cancer to the considerations of risk and benefits of long-term aspirin use," Dr. Grainge summarised.

[Presentation title: Aspirin for the Prevention of Colorectal Adenomas: A Meta-Analysis of the Randomized Clinical Trials. Abstract OP386]

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