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Previous Volume 355:885-895 August 31, 2006 Number 9 Next

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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. (ClinicalTrials.gov number, NCT00141193 [ClinicalTrials.gov] .)

Source Information

From the Integrated Cancer Prevention Center, Tel Aviv Sourasky Medical Center, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (N.A.); Pfizer, New York (C.J.E., M.J.L., P.G., J.T., R.B.R., K.M., P.B.); the Institute for Clinical and Experimental Medicine, Prague (J.S.); Faculty Hospital Brno Bohunice, Brno (P.D.), Faculty Hospital Královské Vinohrady, Prague (J.H.); and Central Military Hospital, Prague (M.Z.) — all in the Czech Republic; Petz Aladár County Hospital, Gyõr, Hungary (I.R.); Statistics Collaborative, Washington, D.C. (R.F., J.W.); Memorial Sloan-Kettering Cancer Center, New York (A.G.Z.); Brigham and Women's Hospital, Boston (S.D.S.); and the Division of Cancer Prevention and Population Sciences, the University of Texas M.D. Anderson Cancer Center, Houston (B.L.).

Address reprint requests to Dr. Levin at the Division of Cancer Prevention and Population Sciences, the University of Texas M.D. Anderson Cancer Center, 1155 Pressler St., Unit 1370, Houston, TX 77030-4009.

Full Text of this Article

Related Letters:

Risks and Benefits of Celecoxib to Prevent Colorectal Adenomas
Andersohn F., Suissa S., Garbe E., Solomon S., Wittes J., Arber N., Bertagnolli M., Hawk E., Levin B., the APC and PreSAP Trial Investigators , Psaty B. M., Potter J. D.
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N Engl J Med 2006; 355:2371-2373, Nov 30, 2006. Correspondence

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