[Selective cyclooxygenase-2 inhibitors for the prevention of colorectal adenomas: a meta-analysis].
OBJECTIVE
To determine the validity and safety of selective cyclooxygenase (COX)-2 inhibitors for the prevention of colorectal adenomas.


METHODS
The relevant data were retrieved from Medline (1966 to 2006), OVID (1996 to January 2007), EMBASE (1980 to January 2007), Chinese Cochrane Centre databases (up to January 2007) and Chinese Biological Medicine Disk (CBM disk, 1997 to 2007). Methodological quality assessment was based on the Cochrane Reviewers' Handbook and Jadad's Score Scale. Statistical software RevMan4.2 was used for meta-analysis.


RESULTS
Six randomized clinical trials (5708 patients) were included in the study. Compared with placebo, selective COX-2 inhibitors lowered the detection rates of both adenomas and advanced adenomas (RR: 0.70, 95% CI: 0.55 - 0.88, P = 0.0003 and RR: 0.69, 95% CI: 0.53 - 0.89, P = 0.005). No significant difference was observed in the number of adverse events between patients taking selective COX-2 inhibitors and those taking placebo (RR: 1.07, 95% CI: 0.98 - 1.17, P = 0.11). Compared with placebo, selective COX-2 inhibitors increased the risk of cardiovascular events (RR: 1.21, 95% CI: 1.09 - 1.33, P = 0.0002).


CONCLUSIONS
Selective COX-2 inhibitors can induce sufficient regression of colorectal adenomatous polyps and thus be used for chemoprevention of colorectal neoplasms. However, because of the potential cardiovascular events, it is not routinely recommended for this indication.
Jin
Xi-feng
XF
Department of Gastroenterology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai 200001, China.
Tong
Jin-lu
JL
Ran
Zhi-hua
ZH
D000236:Adenoma / Q000188:drug therapy*; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D016032:Randomized Controlled Trials as Topic
D052246:Cyclooxygenase 2 Inhibitors