Can Eicosapentaenoic Acid or Aspirin Prevent Colorectal Adenomas?
Posted: Monday, March 11, 2019
There appeared to be no difference in the prevention of adenoma among patients with high-risk findings on colonoscopy treated with omega-3 polyunsaturated fatty acid eicosapentaenoic acid (EPA), aspirin, both, or placebo, according to a U.K. trial, published in The Lancet. After 1 year, Mark A. Hull, FRCP, of the University of Leeds, United Kingdom, and colleagues found similar adenoma detection rates across all treatment groups.
The double-blind, 2 x 2 factorial trial identified “high-risk” patients during colonoscopy in the English Bowel Cancer Screening Programme. Patients were considered to be at high risk if they had at least 3 adenomas and at least 1 was more than 10 mm in diameter or if they had at least 5 adenomas and they were all less than 10 mm in diameter. The authors randomly assigned patients to receive EPA (n = 179), aspirin (n = 177), both (n = 177), or placebo (n = 176).
The investigators found no difference in the mean number of adenomas per patient across the groups: placebo (1.4), EPA (1.6), aspirin (1.3), or combination therapy (1.0). There was no evidence of a treatment effect between EPA and no EPA (P = .81) or aspirin and no aspirin (P = .88).
Adverse events occurred in 44% of the placebo group, 46% of the EPA group, 39% of the aspirin group, and 45% of the combination group. Patients treated with EPA experienced more gastrointestinal adverse events (n = 146) than did those who received placebo (n = 85), aspirin (n = 86), and combination therapy (n = 68).
“Further research is needed regarding the effect on colorectal adenoma number according to adenoma type and location,” the authors concluded. “Optimal use of EPA and aspirin might need a precision medicine approach to adenoma recurrence.”
Disclosure:The study authors’ disclosure information may be found at thelancet.com.