Celecoxib for the prevention of colorectal adenomatous polyps

Nadir Arber, Craig J. Eagle, Julius Spicak, István Rácz, Petr Dite, Jan Hajer, Miroslav Zavoral, Maria J. Lechuga, Paola Gerletti, Jie Tang, Rebecca B. Rosenstein, Katie Macdonald, Pritha Bhadra, Robert Fowler, Janet Wittes, Ann G. Zauber, Scott D. Solomon, Bernard Levin

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800 Citations (Scopus)

Abstract

BACKGROUND: Overexpression of cyclooxygenase 2 (COX-2) has been associated with colorectal adenomatous polyps and cancer, prompting researchers to propose its inhibition as a chemopreventive intervention. METHODS: The Prevention of Colorectal Sporadic Adenomatous Polyps trial was a randomized, placebo-controlled, double-blind study of the COX-2 inhibitor celecoxib given daily in a single 400-mg dose. At 107 centers in 32 countries, we randomly assigned 1561 subjects who had had adenomas removed before enrollment to receive celecoxib (933 subjects) or placebo (628 subjects) daily, after stratification according to the use or nonuse of low-dose aspirin. The primary outcome was detection of adenomas at either year 1 or year 3 by colonoscopy and was compared among the groups with the use of the Mantel - Cox test. RESULTS: Colonoscopies were performed at year 1 on 88.7 percent of the subjects who had undergone randomization and at year 3 on 79.2 percent. Of the 557 subjects in the placebo group and the 840 subjects in the celecoxib group who were included in the efficacy analysis, 264 and 270, respectively, were found to have at least one adenoma at year 1, at year 3, or both. The cumulative rate of adenomas detected through year 3 was 33.6 percent in the celecoxib group and 49.3 percent in the placebo group (relative risk, 0.64; 95 percent confidence interval, 0.56 to 0.75; P<0.001). The cumulative rate of advanced adenomas detected through year 3 was 5.3 percent in the celecoxib group and 10.4 percent in the placebo group (relative risk, 0.49; 95 percent confidence interval, 0.33 to 0.73; P<0.001). Adjudicated serious cardiovascular events occurred in 2.5 percent of subjects in the celecoxib group and 1.9 percent of those in the placebo group (relative risk, 1.30; 95 percent confidence interval, 0.65 to 2.62). CONCLUSIONS: The use of 400 mg of celecoxib once daily significantly reduced the occurrence of colorectal adenomas within three years after polypectomy.

Original languageEnglish
Pages (from-to)885-895
Number of pages11
JournalNew England Journal of Medicine
Volume355
Issue number9
DOIs
Publication statusPublished - Aug 31 2006

ASJC Scopus subject areas

  • Medicine(all)

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    Arber, N., Eagle, C. J., Spicak, J., Rácz, I., Dite, P., Hajer, J., Zavoral, M., Lechuga, M. J., Gerletti, P., Tang, J., Rosenstein, R. B., Macdonald, K., Bhadra, P., Fowler, R., Wittes, J., Zauber, A. G., Solomon, S. D., & Levin, B. (2006). Celecoxib for the prevention of colorectal adenomatous polyps. New England Journal of Medicine, 355(9), 885-895. https://doi.org/10.1056/NEJMoa061652