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5-aminosalicylic acid offered no protection against colorectal cancer
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A recent study found no protective association between 5-aminosalicylic acid and colorectal cancer in patients with IBD.
Researchers performed a meta-analysis of four observational studies evaluating the association between colorectal neoplasia and the use of 5-aminosalicylic acid (5-ASA) for longer than 1 year in patients with IBD. The four studies encompassed 45 years and included 608 patients and 2,177 controls. A sensitivity analysis also was performed involving a fifth study that incorporated 5-ASA use for 3 months or more. All incorporated studies were based on nonreferral populations.
A pooled adjusted OR of 0.95 (95% CI, 0.66-1.38) was calculated for neoplasia with 5-ASA use, but investigators observed a moderate degree of heterogeneity in the studies (I2=58.2%; P=.07). The pooled adjusted OR from the sensitivity analysis was 0.82 (95% CI, 0.54-1.26), with an increased amount of heterogeneity (I2=72.5%; P=.006). Additional sensitivity analyses in which each study was excluded one at a time did not significantly change the adjusted OR, which ranged from 0.87 to 1.08. No significant association was established between 5-ASA use and neoplasia during any of the analyses.
In a separate meta-analysis, researchers evaluated nine clinic-based studies on the association between 5-ASA and colorectal cancer, and calculated a desirable pooled OR of 0.58 (95% CI, 0.45-0.75) with minimal heterogeneity (I2=0%; P<.49).
“While the beneficial effects of 5-ASA on cancer prevention are biologically plausible, the clinical evidence for this relationship remains insufficient given the methodological limitations of observational studies — among them selection bias and heterogeneity,” the researchers concluded. “5-ASA still has a prominent role in the management of mild-to-moderate [ulcerative colitis]. However, for patients who are being treated with more effective long-term maintenance drugs … the benefits of continuing concomitant 5-ASA for [colorectal cancer] prevention remain unclear.”
Disclosure: See the study for a full list of relevant disclosures.
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