(1)
Familial adenomatous polyposis is a
genetic disorder associated with multiple adenomatous colorectal
polyps that invariably progress to
colorectal cancer. Gastroduodenal polyposis and extra-gastrointestinal
desmoid tumours are other major sources of morbidity in these patients. (2) The current strategy used to prevent
colorectal cancer in patients with APC gene mutations consists of yearly monitoring starting in adolescence, and prophylactic
colectomy in early adulthood if polyposis occurs. (3) On the basis of pathophysiological, experimental and epidemiological evidence, some specialists have postulated that certain nonsteroidal antiinflammatory drugs (
NSAIDs) might have a preventive effect on colorectal
adenomas and
cancer. (4)
Aspirin and
sulindac were tested for the prevention of
polyps in patients with
familial adenomatous polyposis, with uncertain results and weak evidence of effectiveness. (5)
Celecoxib was tested in a comparative randomised double-blind trial lasting 6 months. It involved 77 patients with familial polyposis and colorectal
polyps, and 6 patients with only duodenal
polyps. On the basis of composite endoscopic criteria, a
celecoxib dose of 800 mg/day (but not 200 mg/day) reduced the number and surface area of adenomatous colorectal
polyps in patients with
familial adenomatous polyposis. It is not known whether
celecoxib also reduced the risk of
colorectal cancer. A global qualitative analysis suggested that
celecoxib was also effective in reducing duodenal
polyps. (6) Nearly one-third of patients receiving
celecoxib 800 mg/day in this trial developed rectal
bleeding. Another preventive trial was stopped when an excess of cardiovascular events was found in patients taking
celecoxib. (7) The long-term risk-benefit balance of
celecoxib 800 mg/day is not known nor whether efficacy persists
after treatment discontinuation. (8) In practice, it is better not to use
celecoxib to prevent
colorectal cancer: its efficacy has not been demonstrated, even in familial polyposis, and it carries a major risk of
bleeding and cardiovascular events.