Cheung, KS;
Chen, L;
Chan, EW;
Seto, WK;
Wong, I;
Leung, WK;
(2020)
Non-steroidal anti-inflammatory drugs but not aspirin are associated with a lower risk of post-colonoscopy colorectal cancer.
Alimentary Pharmacology and Therapeutics
, 51
(9)
pp. 899-908.
10.1111/apt.15693.
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Abstract
Background: Although non-steroidal anti-inflammatory drugs (NSAIDs) reduces colorectal cancer (CRC) risk, its role in preventing post-colonoscopy CRC remains undetermined. Aims: We aimed to investigate whether NSAIDs could reduce PCCRC risk after a negative baseline colonoscopy. Methods: This is a retrospective cohort study based on a territory-wide healthcare database of Hong Kong. All patients (aged 40 or above) who underwent colonoscopies between 2005 and 2013. Exclusion criteria included CRC detected within six months of index colonoscopy, prior CRC, inflammatory bowel disease and prior colectomy. The primary outcome was post-colonoscopy CRC-3y diagnosed between 6 and 36 months after index colonoscopy. Sites of CRC were categorized as proximal (proximal to splenic flexure) and distal cancer. The adjusted hazards ratio (aHR) of post-colonoscopy CRC-3y with NSAID and aspirin use (defined as cumulative use for 90 days within five years before index colonoscopy) was derived by propensity score (PS) regression adjustment of 22 covariates (including patient’s factors, concurrent medication use and endoscopy center’s performance). Results: Of 187,897 eligible patients, 21,757 (11.6%) were NSAID users. 854 (0.45%) developed post-colonoscopy CRC-3y (proximal cancer:147 [17.2%]). NSAIDs were associated with a lower post-colonoscopy CRC-3y risk (aHR:0.54, 95% CI:0.41–0.70), but not CRC that developed >3years (aHR:0.78, 95% CI 0.56-1.09). The aHR was 0.48 (95% CI:0.24–0.95) for proximal and 0.55 (95% CI:0.40–0.74) for distal cancer. A duration- and frequency-response relationship was observed (p-trend<0.001). For aspirin, the aHR was 1.01 (95% CI:0.80–1.28). Conclusions: Non-aspirin NSAIDs were associated with lower post-colonoscopy CRC risk after a negative baseline colonoscopy.
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