Dr Alaa Rostom and colleagues from Canada examined the benefits and harms of nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDS), and cyclooxygenase (COX) inhibitors for the prevention of colorectal cancer and adenoma.
The research team searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials.
The team also searched the Cochrane Collaboration's registry of clinical trials, and Cochrane Database of Systematic Reviews.
|Ulcer complication rate with nonaspirin NSAIDS is 2% per year|
|Annals of Internal Medicine|
The team identified randomised trials, case-control and cohort studies of the effectiveness of nonsteroidal anti-inflammatory drugs for colorectal cancer prevention.
The trials were evaluated by multilevel screening by 2 independent reviewers.
The team searched systematic reviews for adverse effects.
Data abstraction, checking, and quality assessment were completed in duplicate.
The researchers found that a single cohort study showed no effect of nonaspirin nonsteroidal anti-inflammatory drugs on death due to colorectal cancer.
Colorectal cancer incidence was reduced with nonaspirin nonsteroidal anti-inflammatory drugs in cohort and case-control studies.
Colorectal adenoma incidence was also reduced with nonaspirin nonsteroidal anti-inflammatory drugs use in cohort and case-control studies.
The team found that cyclooxygenase inhibitors reduced colorectal adenoma incidence in randomized, controlled trials.
The researchers observed that the ulcer complication rate associated with nonaspirin nonsteroidal anti-inflammatory drugs is 2% per year.
Compared with nonsteroidal anti-inflammatory drugs, cyclooxygenase inhibitors reduce this risk.
However, the team found that in multiyear use, cyclooxygenase inhibitors have a higher ulcer complication rate than placebo.
The limitation is that cyclooxygenase-2 inhibitors and nonnaproxen nonsteroidal anti-inflammatory drugs increase the risk for serious cardiovascular events.
The team reported that heterogeneity in the dose, duration and frequency of use necessitated careful grouping for analysis.
Dr Rostom's team concluded, “Cyclooxygenase inhibitors and nonsteroidal anti-inflammatory drugs reduce the incidence of colonic adenomas.”
“Nonsteroidal anti-inflammatory drugs also reduce the incidence of colorectal cancer.”
“However, these agents are associated with important cardiovascular events and gastrointestinal harms.”
“The balance of benefits to risk does not favor chemoprevention in average-risk individuals.”