POEMs

Patient-Oriented Evidence That Matters

Aspirin, Eicosapentaenoic Acid, and Placebo Equally Effective in Preventing Colorectal Adenomas in High-Risk Patients

 

Am Fam Physician. 2019 Jun 1;99(11):717.

Clinical Question

Is aspirin or eicosapentaenoic acid (EPA) effective in preventing colorectal adenomas in patients with previous high-risk colorectal neoplasia?

Bottom Line

After 12 months, neither aspirin nor EPA, alone or in combination, are any better than placebo at preventing colorectal adenomas in patients with high-risk neoplasia. (Level of Evidence = 1b)

Synopsis

The Systematic Evaluation of Aspirin and Fish Oil (seAFOod) Polyp Prevention Trial was a factorial trial that randomized patients with high-risk colorectal neoplasms detected on screening colonoscopy. The included patients had three or more adenomas, one of which had to be 1 cm in diameter, or they had five or more smaller adenomas. The researchers randomized patients to receive EPA (1,000 mg twice daily; n = 179) plus placebo, aspirin (300 mg daily; n = 177) plus placebo, EPA plus aspirin (n = 177); or placebo plus placebo (n = 176). The researchers performed a follow-up colonoscopy 12 months after enrollment. Sixty-six patients (9%) did not have a follow-up colonoscopy and were excluded from the analysis. The rate of subsequent adenomas at follow-up was high (61% to 63%) and not statistically significantly different for each group. The rate of adverse events was low in all groups.

Study design: Randomized controlled trial (double-blinded)

Funding source: Government

Allocation: Concealed

Setting: Outpatient (any)

Reference: Hull MA, Sprange K, Hepburn T, et al.; seAFOod Collaborative Group. Eicosapentaenoic acid and aspirin, alone and in combination, for the prevention of colorectal adenomas (seAFOod Polyp Prevention trial): a multicentre, randomised, double-blind, placebo-controlled, 2 × 2 factorial trial. Lancet. 2018;392(10164):2583–2594.

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see https://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

 

 

Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP


Editor's Collections


Related Content


More in Pubmed

MOST RECENT ISSUE


Sep 15, 2019

Access the latest issue of American Family Physician

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article