Farooq Umer, El Alayli Abdallah, Duvvuri Abhiram, Mansour Razan, Pasam Ravi Teja, Malireddy Sahithi, Mustafa Reem A, Bansal Ajay
Department of Internal Medicine, Loyola Medicine/MacNeal Hospital, Berwyn, Illinois.
Department of Internal Medicine, Saint Louis University, St Louis, Missouri.
Gastro Hep Adv. 2023 Jun 10;2(7):1005-1013. doi: 10.1016/j.gastha.2023.05.009. eCollection 2023.
Published literature shows mixed reports of the benefits of nonsteroidal anti-inflammatory drugs (NSAIDs) on reducing colorectal polyps in patients with familial adenomatous polyposis (FAP). We conducted a systematic review and performed a meta-analysis to assess the impact of NSAIDs on colorectal polyp burden in patients with FAP.
We searched PubMed, EMBASE, and Cochrane for randomized controlled trials (RCTs) comparing the effect of NSAIDs vs placebo on the percent change in polyp number and polyp size in patients with FAP. Mean differences between the 2 study arms were pooled using RevMan. The risk of bias (RoB) was assessed using the Cochrane Risk of Bias tool for RCTs, and certainty in the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology.
The search strategy identified 1021 studies, out of which we included 8 RCTs with a total of 279 patients. Treatment for 6.4 ± 2.2 months with NSAIDs reduced polyp numbers by -17.4% (95% confidence interval -26.41%, -8.29%) (low certainty [I 89%] due to imprecision and issues with RoB) and polyp size by -15.9% (95% confidence interval -24.98%, -6.73%) (very low certainty (I 84%) due to imprecision, inconsistency, and issues with RoB). The most common gastrointestinal adverse events reported were stomatitis, diarrhea, and abdominal pain. Side effects leading to drug discontinuation were gastroenteritis and drug allergy.
Short-term use of NSAIDs reduced polyp number and polyp size but with low to very low certainty of evidence. Further large multicenter studies are needed to further explore NSAIDs as a chemopreventive measure in patients with FAP.
已发表的文献对于非甾体抗炎药（NSAIDs）在减少家族性腺瘤性息肉病（FAP）患者结直肠息肉方面的益处报道不一。我们进行了一项系统评价并开展荟萃分析，以评估NSAIDs对FAP患者结直肠息肉负担的影响。
我们在PubMed、EMBASE和Cochrane数据库中检索了比较NSAIDs与安慰剂对FAP患者息肉数量和息肉大小百分比变化影响的随机对照试验（RCT）。使用RevMan对两个研究组之间的平均差异进行汇总。使用Cochrane随机对照试验偏倚风险工具评估偏倚风险（RoB），并使用推荐分级评估、制定和评价方法评估证据的确定性。
检索策略共识别出1021项研究，其中我们纳入了8项RCT，共279例患者。使用NSAIDs治疗6.4±2.2个月可使息肉数量减少-17.4%（95%置信区间-26.41%，-8.29%）（由于不精确性和RoB问题，证据确定性低[I 89%]），息肉大小减少-15.9%（95%置信区间-24.98%，-6.73%）（由于不精确性、不一致性和RoB问题，证据确定性极低[I 84%]）。报告的最常见胃肠道不良事件为口腔炎、腹泻和腹痛。导致停药的副作用为肠胃炎和药物过敏。
短期使用NSAIDs可减少息肉数量和息肉大小，但证据确定性低至极低。需要进一步开展大型多中心研究，以进一步探索NSAIDs作为FAP患者化学预防措施的作用。
