Format

Send to

Choose Destination
Gastroenterology. 2006 Dec;131(6):1674-82. Epub 2006 Sep 1.

A randomized trial of rofecoxib for the chemoprevention of colorectal adenomas.

Author information

1
Department of Medicine, the Norris Cotton Cancer Center, Dartmouth Medical School, Hanover, New Hampshire, USA. John.A.Baron@Dartmouth.edu

Abstract

BACKGROUND & AIMS:

In human and animal studies, nonsteroidal anti-inflammatory drugs have been associated with a reduced risk of colorectal neoplasia. Although the underlying mechanisms are unknown, inhibition of cyclooxygenase (COX), particularly COX-2, is thought to play a role. We conducted a randomized, placebo-controlled, double-blind trial to assess whether use of the selective COX-2 inhibitor rofecoxib would reduce the risk of colorectal adenomas.

METHODS:

We randomized 2587 subjects with a recent history of histologically confirmed adenomas to receive daily placebo or 25 mg rofecoxib. Randomization was stratified by baseline use of cardioprotective aspirin. Colonoscopic follow-up evaluation was planned for 1 and 3 years after randomization. The primary end point was all adenomas diagnosed during 3 years' treatment. In a modified intent-to-treat analysis, we computed the relative risk of any adenoma after randomization, using Mantel-Haenszel statistics stratified by low-dose aspirin use at baseline.

RESULTS:

Adenoma recurrence was less frequent for rofecoxib subjects than for those randomized to placebo (41% vs 55%; P < .0001; relative risk [RR], 0.76; 95% confidence interval [CI], 0.69-0.83). Rofecoxib also conferred a reduction in risk of advanced adenomas (P < .01). The chemopreventive effect was more pronounced in the first year (RR, 0.65; 95% CI, 0.57-0.73) than in the subsequent 2 years (RR, 0.81; 95% CI, 0.71-0.93). As reported previously, rofecoxib was associated with increased risks of significant upper gastrointestinal events and serious thrombotic cardiovascular events.

CONCLUSIONS:

In this randomized trial, rofecoxib significantly reduced the risk of colorectal adenomas, but also had serious toxicity.

PMID:
17087947
DOI:
10.1053/j.gastro.2006.08.079
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center