Aspirin and folic acid for the prevention of recurrent colorectal adenomas

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 134; no. 1; p. 29
• Main Authors: Logan, Richard F A, Grainge, Matthew J, Shepherd, Vic C, Armitage, Nicholas C, Muir, Kenneth R
• Format: Journal Article
• Language: English
• Published: United States 01.01.2008
• Subjects: Adenoma - therapy; Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Aspirin - therapeutic use; Chemotherapy, Adjuvant; Colonoscopy; Colorectal Neoplasms - therapy; Double-Blind Method; Female; Folic Acid - therapeutic use; Hematinics - therapeutic use; Humans; Male; Middle Aged; Neoplasm Recurrence, Local - prevention & control
• ISSN: 1528-0012
• DOI: 10.1053/j.gastro.2007.10.014

Although observational studies have found regular aspirin use to be associated with a reduced risk of colorectal neoplasia, results from randomized trials using aspirin have been inconsistent. Dietary folate intake also has been found to be associated with a reduced risk of colorectal neoplasms in observational studies. A multicenter, randomized, double-blind trial of aspirin (300 mg/day) and folate supplements (0.5 mg/day) to prevent colorectal adenoma recurrence was performed using a 2 x 2 factorial design. All patients had an adenoma (>/=0.5 cm) removed in the 6 months before recruitment and were followed-up at 4-month intervals with a second colonoscopy after approximately 3 years. The primary outcome measure was a colorectal adenoma diagnosed after baseline. A total of 945 patients were recruited into the study, of whom 853 (90.3%) underwent a second colonoscopy. In total, 99 (22.8%) of 434 patients receiving aspirin had a recurrent adenoma compared with 121 (28.9%) of 419 patients receiving placebo (relative risk, 0.79; 95% confidence interval [CI], 0.63-0.99). A total of 104 patients developed an advanced colorectal adenoma; 41 (9.4%) of these were in the aspirin group and 63 (15.0%) were in the placebo group (relative risk, 0.63; 95% CI, 0.43-0.91). Folate supplementation was found to have no effect on adenoma recurrence (relative risk, 1.07; 95% CI, 0.85-1.34). Aspirin (300 mg/day) but not folate (0.5 mg/day) use was found to reduce the risk of colorectal adenoma recurrence, with evidence that aspirin could have a significant role in preventing the development of advanced lesions.