The efficacy and safety of non-steroidal anti-inflammatory drugs in preventing the recurrence of colorectal adenoma: a meta-analysis and systematic review of randomized trials.
OBJECTIVE
We report a meta-analysis and systematic review of randomized trials assessing the impact of non-steroidal anti-inflammatory drugs (NSAIDs) in preventing recurrence of colorectal adenoma.


METHODS
PubMed/Medicine, EMBASE and the Cochrane Central Register of Controlled Trials databases were searched for relevant randomized double-blind placebo-controlled trials published before March 2014. Two authors independently assessed study quality and extracted data. stata software was used to investigate heterogeneity between studies, and analysis was performed using a fixed-effects model to calculate and merge data.


RESULTS
Nine studies, with 8521 subjects, were included. Results were categorized by the duration of follow-up. The relative risks of any recurrence of adenoma in patients receiving NSAIDs compared with the placebo group were 0.68 [95% confidence interval (CI) 0.63-0.73, P = 0.001] for patients with a 1-year follow-up, 0.75 (95% CI 0.68-0.83, P = 0.246) with 3 years and 1.43 (95% CI 1.14-1.79, P = 0.127) with follow-up of over 3 years. Using pooled risk ratios, NSAIDs were associated with a significant decrease in adenoma recurrence at 1 and 3 years, although this association was lost beyond 3 years of follow-up. For secondary prevention of advanced adenomas, the pooled risk ratios (compared with placebo) were 0.51 (95% CI 0.43-0.60, P = 0.026) after 1 year, 0.61 (95% CI 0.50-0.76, P = 0.887) at 3 years and 1.39 (95% CI 0.89-2.16, P = 0.829) after 3 years.


CONCLUSIONS
The meta-analysis indicated that oral NSAIDs may be effective in the early prevention of secondary occurrence of adenomas.
Postgraduate Training Base of the General Hospital of Jinan Military Command, Liaoning Medical University, Jinan, Shandong, China.
Y
Y
Wang
F-C
FC
Zhang
Y-J
YJ
Wang
D000236:Adenoma / Q000517:prevention & control*; D000284:Administration, Oral; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention; D013997:Time Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal
Colorectal adenomas; aspirin; celecoxib; meta-analysis; recurrence; rofecoxib