P1322 - Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) for Chemoprevention in Patients With Familial Adenomatous Polyposis: A Systematic Review and Meta-Analysis

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Umer Farooq, MD

Loyola Medicine/MacNeal Hospital
Berwyn, IL, United States

Umer Farooq, MD¹, Abdallah El Alayli, MD², Abhiram Duvvuri, MD², Ravi Teja Pasam, MBBS, MPH³, Sahithi Malireddy, ⁴, Razan Mansour, MD², Reem Mustafa, MD, MPH, PhD², Ajay Bansal, MD²
¹Loyola Medicine/MacNeal Hospital, Berwyn, IL; ²University of Kansas Medical Center, Kansas City, KS; ³Lahey Hospital and Medical Center, Burlington, MA; ⁴Dougherty Valley High School, San Ramon, CA

Introduction: Published literature shows mixed reports of the benefits of non-steroidal anti-inflammatory drugs (NSAIDs) in colon cancer prevention in patients with familial adenomatous polyposis (FAP). We conducted a systematic review and performed a meta-analysis to assess the impact of NSAIDs on polyp burden and progression in patients with FAP.

Methods: We searched PubMed, EMBASE, Google Scholar, and Cochrane for randomized controlled trials (RCT) reporting effects of NSAIDs on colorectal polyp regression in patients with FAP (Prospero ID: CRD42021247683). All trials compared the use of NSAIDs (selective or non-selective) versus placebo in 1:1 or 2:1 ratio. The primary endpoints were mean percent change in a) polyp number and b) polyp size. Mean differences (MD) between the two study arms were pooled using random effects model using RevMan and the quality of the evidence was assessed using the Cochrane Risk of Bias tool for RCTs and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.

Results: Over 718 citations were screened, and four trials fit the inclusion criteria. All trials compared the use of NSAIDs and placebo in patients with FAP. The trials included 181 and 55 patients in the NSAIDS and placebo groups respectively (49.7% females, mean age 33 ± 5.4years, mean duration of follow-up 8.25 ± 2.49 months). The NSAIDs used included sulindac, celecoxib, rofecoxib, and tiracoxib (Table.1). The mean duration of NSAIDs treatment was 7.5 ± 2.37 months. The risk of bias was low for all studies. Treatment with NSAIDs reduced both polyp number (MD -24.68% (95% CI -39.45%, -9.1%) I² =95%) (Low certainty) and polyp size (MD -21.69% (95% CI -44.76%, 1.34%); I²=98%) (Low certainty) when compared to placebo (Figure. 1). The most common gastrointestinal adverse events reported in the studies were stomatitis, diarrhea, abdominal pain, while side effects leading to drug discontinuation included gastroenteritis and drug allergy. Neither study reported significant differences in the incidence of any adverse event between NSAIDs and the placebo group.

Discussion: Low certainty evidence showed that short-term NSAID use reduced polyp number by ~25% and polyp size by ~22%. Further studies are needed before NSAIDs can be universally recommended for colon cancer chemoprevention in FAP.

Figure: Panel-A: Polyp Number, Panel-B: Polyp Size

Study	Number of Patients	Female, %	Intervention Drug	Intervention Duration, months	Follow-up Duration, months	Colectomy Status
Giardiello et al.	22	59.09	Sulindac	9	12	Mixed*
Steinbach et al.	77	42.85	Celecoxib	6	6	No
Higuchi et al.	21	47.61	Rofecoxib	9	9	Mixed*
Iwama et al.	60	57.37	Tiracoxib	6	6	No
Mixed: Study had both kinds of patients with entire colon present as well as who underwent colectomy with ileorectal anastomosis.

Table: Study Characteristics

Disclosures:

Umer Farooq indicated no relevant financial relationships.

Abdallah El Alayli indicated no relevant financial relationships.

Abhiram Duvvuri indicated no relevant financial relationships.

Ravi Teja Pasam indicated no relevant financial relationships.

Sahithi Malireddy indicated no relevant financial relationships.

Razan Mansour indicated no relevant financial relationships.

Reem Mustafa indicated no relevant financial relationships.

Ajay Bansal indicated no relevant financial relationships.

Umer Farooq, MD¹, Abdallah El Alayli, MD², Abhiram Duvvuri, MD², Ravi Teja Pasam, MBBS, MPH³, Sahithi Malireddy, ⁴, Razan Mansour, MD², Reem Mustafa, MD, MPH, PhD², Ajay Bansal, MD². P1322 - Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) for Chemoprevention in Patients With Familial Adenomatous Polyposis: A Systematic Review and Meta-Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.