Can Celebrex Help Prevent Colorectal Polyps?
Two new studies in the August 31, 2006 New England Journal of Medicine investigated the effects of celecoxib in people who had colorectal polyps removed. The researchers found that celecoxib was associated with a reduced risk of recurrent polyps, but one of the studies suggested that the medication may be associated with serious cardiovascular problems.
About the Study
The participants in both studies had precancerous colorectal polyps removed during
In the first study, the participants taking celecoxib were 36% less likely than those taking the placebo to have a colorectal polyp detected within three years. In the second study, the participants taking 200 milligrams of celecoxib twice daily were 57% less likely than those taking the placebo to have a polyp detected within three years, while those taking 400 milligrams of celecoxib twice daily were 66% less likely.
Also in the second study, a safety committee found that celecoxib was associated with a two- to three-fold increased risk of serious cardiovascular events (death from cardiovascular causes,
Both studies were limited because the end point was the detection of colorectal polyps—not the development of colorectal cancer. However, it would be ethically problematic to follow study participants until they developed cancer when simply removing the precancerous polyps would effectively prevent the cancer from ever occurring.
How Does This Affect You?
These studies suggest that celecoxib may help prevent the formation of precancerous colorectal polyps in people who have already had polyps removed. Celecoxib may be even more effective than aspirin, which has been shown to reduce the recurrence of colorectal polyps by approximately 20%, compared with the 36-66% reductions seen in these studies.
But the increased risk of serious cardiovascular events found in the second study is concerning. It is not clear that the benefits of taking celecoxib to reduce the possibly of recurrent polyps outweighs its risks for most patients. For now, doctors and patients need to decide who should take celecoxib on a case-by-case basis. The medication, for example, may be most appropriate for patients at extremely high risk of recurrent polyps (eg, strong family history or personal history of colorectal cancer) who cannot tolerate other more conventional forms of NSAIDs. If you fall into this category, you may wish to discuss the possibility of taking celecoxib with your doctor.
American Cancer Society
National Cancer Institute
Arber N, Eagle CJ, Spicak J, et al. Celecoxib for the prevention of colorectal adenomatous polyps. N Engl J Med . 2006;355:885-895.
Bertagnolli MM, Eagle CJ, Zauber AG, et al. Celecoxib for the prevention of sporadic colorectal adenomas. N Engl J Med . 2006;355:873-884.
Last reviewed August 2006 by
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