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Title: Efficacy and safety of chemopreventive agents on colorectal cancer incidence and mortality: Systematic review and network meta-analysis
Authors: Sajesh K. Veettil
Peerawat Jinatongthai
Surakit Nathisuwan
Nattawat Teerawattanapong
Siew Mooi Ching
Kean Ghee Lim
Surasak Saokaew
Pochamana Phisalprapa
Christopher M. Reid
Nathorn Chaiyakunapruk
University of Phayao
University of Wisconsin-Madison
Curtin University
Ubon Rajathanee University
Universiti Putra Malaysia
Naresuan University
Monash University
Monash University Malaysia
Mahidol University
Faculty of Medicine, Siriraj Hospital, Mahidol University
International Medical University
Keywords: Medicine
Issue Date: 1-Jan-2018
Citation: Clinical Epidemiology. Vol.10, (2018), 1433-1445
Abstract: © 2018 Veettil et al. Background: Various interventions have been tested as primary prevention of colorectal cancers (CRC), but comprehensive evidence comparing them is absent. We examined the effects of various chemopreventive agents (CPAs) on CRC incidence and mortality. Methods: We did a network meta-analysis based on a systematic review of randomized controlled trials (RCTs) that compared at least one CPA (aspirin, antioxidants, folic acid, vitamin B6, vitamin B12, calcium, vitamin D, alone or in combination) to placebo or other CPA in persons without history of CRC. Several databases were searched from inception up to March 2017. Primary outcomes were early and long-term CRC incidence and mortality. Results: Twenty-one RCTs comprising 281,063 participants, 9 RCTS comprising 160,101 participants, and 7 RCTs comprising 24,001 participants were included in the network meta-analysis for early risk of CRC incidence, long-term risk of CRC incidence and mortality, respectively. For early CRC incidence, no CPAs were found to be effective. For long-term CRC incidence and mortality, aspirin was the only intervention that showed protective effects with potential dose-dependent effects (risk ratio [RR], 0.74 [95% CI, 0.57–0.97] for high-dose [≥325 mg/day] and RR, 0.81 [95% CI, 0.67–0.98] for very-low-dose [≤100 mg/day]). Similar trend was found for mortality (RR, 0.43 [95% CI, 0.23–0.81] for low-dose [>100–325 mg/day] and RR, 0.65 [95% CI, 0.45–0.94] for very-low-dose). However, in net clinical benefit analysis, when combining risk estimates on mortality from CRC, cardiovascular disease, and pooled risk estimates of major gastrointestinal bleeding, low-dose aspirin provided the highest net survival gain (%) of 1.736 [95% CI, 1.010–2.434]. Conclusion: Aspirin at the dose range of 75–325 mg/day is a safe and effective primary prevention for long-term CRC among people at average risk. None of the other CPAs were found to be effective. There may potentially be differential effects among various doses of aspirin that needs further investigation.
ISSN: 11791349
Appears in Collections:Scopus 2018

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