Low-dose aspirin suppresses colorectal polyp recurrence
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Low-dose aspirin suppressed the recurrence of colorectal polyps in patients with familial adenomatous polyposis, according to research in The Lancet Gastroenterology & Hepatology.
“The standard treatment for familial adenomatous polyposis (FAP) is total colectomy. However, after total colectomy, patient quality of life is often greatly reduced,” Hideki Ishikawa, MD, department of molecular-targeting cancer prevention at Kyoto Prefectural University of Medicine, and colleagues wrote. “Chemopreventive agents are not fully recommended; the evidence for their benefit is insufficient for FAP. ... As such, non-surgical approaches to treat FAP are needed that can reduce the number and size of adenomas or prevent the development of colorectal cancer without severe side effects.”
In a double-blind, placebo-controlled, multicenter trial, researchers analyzed 104 patients (aged 16 years to 70 years) with FAP for the effects of low-dose aspirin (100 mg) and mesalazine (2 g) on the recurrence of colorectal polyps. Eligible patients had no history of colectomy and underwent pre-intervention endoscopic colorectal poly removal. Researchers randomly assigned patients to receive either aspirin plus mesalazine, aspirin plus mesalazine placebo, aspirin placebo plus mesalazine or aspirin placebo plus mesalazine placebo. The primary endpoint was the incidence of colorectal polyps of at least 5 mm; treatment continued until 1 week before an 8-month colonoscopy.
Study results yielded colorectal polyps of at least 5 mm in 50% of patients who did not receive aspirin, 30% of patients who received aspirin, 42% of patients who did not receive mesalazine and 38% of patients who received mesalazine. Adjusted odds of polyp recurrence was 0.37 (95% CI, 0.16-0.86) in patients who received aspirin vs. 0.87 (95% CI, 0.38-2) in patients who received mesalazine. Researchers noted the most common adverse events were low grade upper GI symptoms.
“Although mesalazine had little effect, low-dose aspirin safely reduced the prevalence of colorectal polyps of at least 5 mm at 8 months in patients with FAP,” Ishikawa and colleagues concluded. “Low-dose aspirin could therefore be a useful cancer chemopreventive drug for colorectal prevention in patients with FAP.”
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