Oral aspirin for preventing colorectal adenoma recurrence: A systematic review and network meta-analysis of...

Area of Science:

• Gastroenterology
• Oncology
• Pharmacology

Background:

• Colorectal adenomas can progress to malignancy if untreated.
• The optimal aspirin dosage for preventing adenoma recurrence is unclear.
• Previous trials have investigated aspirin's efficacy, but dose-response relationships require clarification.

Purpose of the Study:

• To clarify the relationship between aspirin dose and colorectal adenoma recurrence.
• To compare the efficacy of low-dose aspirin (LDA) versus high-dose aspirin (HDA) and placebo.
• To evaluate aspirin's effectiveness in preventing adenoma recurrence in at-risk individuals.

Main Methods:

• Conducted a network meta-analysis of eight randomized controlled trials (RCTs).
• Included studies comparing aspirin (low or high dose) alone or combined with other medications against placebo.
• Assessed risk of bias using ROB 2.0 and confidence in results with CINeMA.

Main Results:

• Low-dose aspirin (LDA <300 mg/day) showed greater efficacy than high-dose aspirin (HDA ≥300 mg/day) and placebo.
• Risk ratios for LDA vs. HDA and placebo were 0.76 (95% CI: 0.58-0.99) and 0.70 (95% CI: 0.54-0.91), respectively.
• Trial sequential analysis indicated LDA efficacy against placebo only exceeded optimal information size.

Conclusions:

• Low-dose aspirin demonstrates statistically significant efficacy in preventing colorectal adenoma recurrence.
• The comparative efficacy of LDA versus HDA remains uncertain, necessitating further investigation.
• Further clinical trials are required to definitively establish the optimal aspirin dosage for adenoma prevention.