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Oral aspirin for preventing colorectal adenoma recurrence: a systematic review and network meta-analysis of randomized controlled trials

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Objective To evaluate the preventive effect of aspirin on polypoid lesions in the colorectum and recommend the optimal dose for clinical useDesign Systematic review and network meta-analysisData sources A multilingual, comprehensive source of aspirin clinical trials for colorectal adenoma preventio

n updated to December 31st, 2021Study selection Only randomized controlled trial studies, consisting of participants randomly assigned to receive aspirin (high dose or low dose) or placebo, were included.Methods Pairwise meta-analysis, meta-regression, trial sequential analysis, and network meta-ana

lysis were done after all eligible studies inclusion. ROB 2.0 tool was used for assess risk of bias assessments in included studies, and confidence in the results of network meta-analysis was evaluated by using CINeMA approach.Results The network meta-analysis included eight randomized controlled tr

ials (nine reports) – four of aspirin (low dose or high dose) alone (n = 1,820 participants), four of aspirin in combination with one another medication including folic acid (n = 421), resistant starch (n = 342), eicosapentaenoic acid (n = 326) and mesalazine (n = 102), all compared to placebo. For

pairwise meta-analysis, based on data from seven trials aspirin (any dose) substantially reduced the colorectal adenoma recurrence in participants with or without adenoma-related genetic syndromes (risk ratio 0.86, 95% confidence interval: 0.75 to 0.99). Meta-regression indicated that there was no

correlation between aspirin dose and colorectal adenoma recurrence (p-value = 0.58 for linear model, p-value = 0.76 for non-linear model). For network meta-analysis, low-dose aspirin was still more protective than both high-dose aspirin and placebo, with risk ratio and 95% confidence interval being

0.76 (95% confidence interval 0.58 – 0.99), 0.7 (95% confidence interval 0.54 – 0.91), respectively. Synchronously, low-dose aspirin was ranked the best treatment among the network of low-dose, high-dose aspirin, and placebo (P-score = 0.99). Thus, LDA was the optimal treatment relative to HDA and p

lacebo (P-score = 0.99) with moderate certainty of evidence due to some concerns in heterogeneity. But for trial sequential analysis, low-dose aspirin only showed its efficacy over placebo when the number of included participants exceeded the optimal information size, this was not the case for HDA.C

onclusions Low-dose aspirin has statistically significant efficacy in colorectal adenoma prevention, especially for long-term use but its efficacy over high-dose aspirin is uncertain based on available data which needs more trials to confirm.