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Risks of Colorectal Neoplasms and Cardiovascular Thromboembolic Events after the Combined Use of Selective COX-2 Inhibitors and Aspirin with 5 Years Follow-up: A Meta-analysis.

Colorectal Disease 2019 January 19
AIM: To evaluate the association between selective COX-2 inhibitors (coxibs) and the risk of colorectal neoplasm and vascular events with and without low-dose aspirin.

METHOD: We searched for randomized controlled trials and comparative studies in PubMed, EMBASE, and Cochrane Library databases using pertinent key terms. Risk ratios (RRs) were calculated for each study with a fixed- or random-effects model.

RESULTS: Eight clinical studies with 44,566 subjects were eligible. Coxib use significantly reduced the overall risk of colorectal neoplasms by 21% (RR = 0.79, 95% CI: 0.70-0.89; P = 0.000). The chemopreventive effect of coxibs was beneficial in the first year (RR = 0.74; 95% CI: 0.58-0.94; P = 0.013), marginal in the third year (RR = 0.79; 95% CI: 0.63-1.01; P = 0.059), and counterproductive in the fifth year (RR = 1.65; 95% CI: 1.23-2.21; P = 0.001). Compared with aspirin use alone, combined use of coxib and aspirin for 3 years increased the risk of colorectal neoplasms by 80% in the fifth year (RR = 1.80; 95% CI: 1.22-2.66; P = 0.003) but decreased by 79% and 30% the risks of cardiovascular thromboembolic events (RR = 1.79; 95% CI: 1.33-2.41; P = 0.0001) and renal impairment/hypertension (RR = 1.30; 95% CI: 1.09-1.54; P = 0.003), respectively, caused by coxib use alone.

CONCLUSION: Coxibs may reduce the overall risk of colorectal neoplasm, but chemopreventive effects are attenuated over time. When participants simultaneously take low-dose aspirin, coxibs may not be useful for chemoprevention of colorectal neoplasms. This article is protected by copyright. All rights reserved.

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