Nonaspirin NSAIDs help prevent postcolonoscopy CRC

Use of nonsteroidal anti‐inflammatory drugs (NSAIDs), except aspirin, is associated with a lower risk of colorectal cancer (CRC) after a negative baseline colonoscopy, a recent study reports.

The retrospective study involved a cohort 187,897 patients aged ≥40 years who underwent colonoscopies (median age at index procedure, 60.6 years; 48.9 percent male). None of the patients had CRC detected within 6 months of index colonoscopy, prior CRC, inflammatory bowel disease and prior colectomy.

There were 21,757 NSAID users (11.6 percent), with a median duration of use of 0.7 years. Fifty-five (0.25 percent) of them developed CRC between 6 and 36 months after index colonoscopy. The resulting 3-year postcolonoscopy (PC)CRC incidence rate was 8.4 per 10,000 person‐years, which was much lower compared with the rate of 16.1 per 10,000 person‐years among NSAID nonusers.

Multivariable Cox proportional analysis confirmed that NSAID use exerted a protective effect on the risk of 3-year PCCRC (adjusted hazard ratio [aHR], 0.54, 95 percent confidence interval [CI], 0.41–0.70) but not on the risk of >3-year PCCRC. The corresponding aHR estimates for proximal and distal cancers were 0.48 (95 percent CI, 0.24–0.95) and 0.55 (95 percent CI, 0.40–0.74).

A duration‐ and frequency-response relationship was seen (p_trend<0.001), such that a longer duration (>1 year; aHR, 0.42, 95 percent CI, 0.26–0.65) and more frequent NSAID use (at least weekly; aHR: 0.46, 95% CI: 0.32‐0.67) conferred greater protection against 3-year PCCRC.

Aspirin, however, provided no risk-reduction benefit (aHR, 1.01, 95 percent CI, 0.80–1.28).

Researchers underscored a need for further investigation to identify the subgroup of patients who will benefit more from NSAIDs, as such drugs are associated with potential adverse effects.