Aminosalicylate Therapy in the Prevention of Dysplasia and Colorectal Cancer in Ulcerative Colitis

doi:10.1016/j.cgh.2006.08.014

Clinical Gastroenterology and Hepatology

Volume 4, Issue 11, November 2006, Pages 1346-1350

Presented at Digestive Disease Week, Orlando, Florida, May 19, 2003.

https://doi.org/10.1016/j.cgh.2006.08.014 Get rights and content

Background & Aims Aminosalicylates have been suggested as chemopreventive agents for colorectal cancer (CRC) in ulcerative colitis (UC). We studied the effect of aminosalicylate use on dysplasia and CRC risk in chronic UC. Methods UC patients with dysplasia or CRC were matched with controls by disease duration, extent, and age at diagnosis. The total amount of aminosalicylates over the duration of the disease and the mean daily amount of drug was calculated. Conditional logistic regression was used to examine the relationship of aminosalicylates to the risk of neoplasia; potential confounders were controlled in a multivariable model. Results Twenty-six cases (8 CRC, 18 dysplasia) were matched with 96 controls. Cases and controls were similar in age (median, 43 vs 42.5 y), age at diagnosis of UC (median, 29.5 vs 30.5 y), duration of UC (median, 11.5 vs 9 y), and extent of disease (58% pancolitis), sex, family history of UC, history of primary sclerosing cholangitis, and smoking history. Cases were more likely to have a family history of CRC than controls (27% of cases, 9% of controls, P = .036). Conditional logistic regression adjusted for disease duration, age at diagnosis, and family history of CRC showed that aminosalicylate use of 1.2 g/day or more was associated with a 72% reduction in the odds of dysplasia/CRC (odds ratio, 0.28; 95% confidence interval, 0.09–0.85). As the total dose of aminosalicylates increased, the odds of dysplasia/CRC decreased (P = .056). Conclusions This case-control study shows a significant risk reduction of dysplasia and CRC in UC patients exposed to aminosalicylate therapy.

Section snippets

Patients

This was designed as a matched case-control study comparing cases with chronic UC who developed dysplasia or CRC with controls with chronic UC without neoplasia. Patients in this study were obtained from the University of Chicago IBD Registry, a tertiary clinical database of all IBD patients evaluated at the University of Chicago from 1985 through the present. We identified UC patients with colitis-related dysplasia or CRC from 1985 to 2000, as well as control patients with UC who did not

Results

We identified 26 cases, of whom 8 had CRC and 18 were diagnosed with dysplasia. Ninety-six controls were matched to the 26 cases, with 3.7 controls per case, on average; the number of controls per case ranged from 1 to 6. The median age of cases at the time of diagnosis of CRC or dysplasia was 43 years (range, 24–76 y). The average age of controls when cases were diagnosed was 42.5 years (range, 21–77 y).

Cases and controls were similar in age, age at diagnosis of UC, and duration of UC, and

Discussion

This case-control study supports the hypothesis that aminosalicylate therapy is associated with a statistically significant reduced risk of dysplasia or CRC in UC patients. In this study, we show that patients taking a (cumulative) average dose of aminosalicylates of 1.2 g/day or more had a 72% risk reduction of neoplasia. We also show a statistically significant dose-response relationship for the cumulative dose of mesalamines decreasing the risk of CRC. Our data also confirm that a family

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: Supported by Procter and Gamble Pharmaceuticals (D.T.R.).

¹: D.T.R. is a consultant and receives financial support from Salix Pharmaceuticals and Shire Pharmaceuticals;

²: S.H. is a consultant and receives financial support from Procter and Gamble Pharmaceuticals, Shire Pharmaceuticals, and Salix Pharmaceuticals.

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Original articleAminosalicylate Therapy in the Prevention of Dysplasia and Colorectal Cancer in Ulcerative Colitis

Section snippets

Patients

Results

Discussion

Gastroenterology

Gastroenterology

Gastroenterology

Gastroenterology

Gastroenterology

Am J Gastroenterol

Colorectal cancer in ulcerative colitis: a cohort study of primary referrals from three centers

Gut

Cancer risk in ulcerative colitis: surveillance or surgery

Br J Surg

Colon cancer, dysplasia, and surveillance in patients with ulcerative colitisA critical review

N Engl J Med

Colorectal cancer in ulcerative colitisInfluence of anatomical extent and age at onset on colitis-cancer interval

Gut

Original article
Aminosalicylate Therapy in the Prevention of Dysplasia and Colorectal Cancer in Ulcerative Colitis