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Onwuka SR, McIntosh J, Macrae F, Chondros P, Boyd L, Wijesuriya R, Saya S, Karnchanachari N, Novy K, Jenkins MA, Walter FM, Trevena L, Gutierrez JM, Broun K, Fishman G, Marker J, Emery J. Should I Take Aspirin? (SITA): randomised controlled trial of a decision aid for cancer chemoprevention. Br J Gen Pract 2024; 74:e498-e507. [PMID: 38527793 PMCID: PMC11257068 DOI: 10.3399/bjgp.2023.0385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/14/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Australian guidelines recommend that people aged 50-70 years consider taking low-dose aspirin to reduce their risk of colorectal cancer (CRC). AIM To determine the effect of a consultation with a researcher before an appointment in general practice using a decision aid presenting the benefits and harms of taking low-dose aspirin compared with a general CRC prevention brochure on patients' informed decision making and low-dose aspirin use. DESIGN AND SETTING Individually randomised controlled trial in six general practices in Victoria, Australia, from October 2020 to March 2021. METHOD Participants were recruited from a consecutive sample of patients aged 50-70 years attending a GP. The intervention was a consultation using a decision aid to discuss taking aspirin to reduce CRC risk while control consultations discussed reducing CRC risk generally. Self-reported co-primary outcomes were the proportion of individuals making informed choices about taking aspirin at 1 month and on low-dose aspirin uptake at 6 months, respectively. The intervention effect was estimated using a generalised linear model and reported with Bonferroni-adjusted 95% confidence intervals (CIs) and P-values. RESULTS A total of 261 participants (86% of eligible patients) were randomised into trial arms (n = 129 intervention; n = 132 control). Of these participants, 17.7% (n = 20/113) in the intervention group and 7.6% (n = 9/118) in the control group reported making an informed choice about taking aspirin at 1 month, an estimated 9.1% (95% CI = 0.29 to 18.5) between-arm difference in proportions (odds ratio [OR] 2.47, 97.5% CI = 0.94 to 6.52, P = 0.074). The proportions of individuals who reported taking aspirin at 6 months were 10.2% (n = 12/118) of the intervention group versus 13.8% (n = 16/116) of the control group, an estimated between-arm difference of -4.0% (95% CI = -13.5 to 5.5; OR 0.68 [97.5% CI = 0.27 to 1.70, P = 0.692]). CONCLUSION The decision aid improved informed decision making but this did not translate into long-term regular use of aspirin to reduce CRC risk. In future research, decision aids should be delivered alongside various implementation strategies.
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Affiliation(s)
- Shakira R Onwuka
- Centre for Cancer Research, University of Melbourne; Department of General Practice and Primary Care, University of Melbourne; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Jennifer McIntosh
- Centre for Cancer Research, University of Melbourne; Department of General Practice and Primary Care, University of Melbourne; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Finlay Macrae
- Colorectal Medicine and Genetics, Royal Melbourne Hospital, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Patty Chondros
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
| | - Lucy Boyd
- Centre for Cancer Research, University of Melbourne; Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
| | - Rushani Wijesuriya
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Sibel Saya
- Centre for Cancer Research, University of Melbourne; Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
| | - Napin Karnchanachari
- Centre for Cancer Research, University of Melbourne; Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
| | - Kitty Novy
- Centre for Cancer Research, University of Melbourne; Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
| | - Mark A Jenkins
- National Health and Medical Research Council Professorial Fellow, cancer epidemiologist, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Fiona M Walter
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK; professor of primary care cancer research, Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
| | - Lyndal Trevena
- Primary Health Care, School of Public Health, University of Sydney, Sydney, Australia
| | - Javiera Martinez Gutierrez
- Centre for Cancer Research, University of Melbourne; Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia; School of Medicine, Family Medicine Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Kate Broun
- Prevention Division, Cancer Council Victoria, Melbourne, Australia
| | - George Fishman
- PC4 Joint Community Advisory Group, University of Melbourne, Melbourne, Australia
| | - Julie Marker
- PC4 Joint Community Advisory Group, University of Melbourne, Melbourne, Australia
| | - Jon Emery
- Centre for Cancer Research, University of Melbourne; Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia; Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Impact of blood type, functional polymorphism (T-1676C) of the COX-1 gene promoter and clinical factors on the development of peptic ulcer during cardiovascular prophylaxis with low-dose aspirin. BIOMED RESEARCH INTERNATIONAL 2014; 2014:616018. [PMID: 25243161 PMCID: PMC4163467 DOI: 10.1155/2014/616018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 07/09/2014] [Indexed: 12/23/2022]
Abstract
Aims. To investigate the impact of blood type, functional polymorphism (T-1676C) of the COX-1 gene promoter, and clinical factors on the development of peptic ulcer during cardiovascular prophylaxis with low-dose aspirin. Methods. In a case-control study including 111 low-dose aspirin users with peptic ulcers and 109 controls (asymptomatic aspirin users), the polymorphism (T-1676C) of the COX-1 gene promoter was genotyped, and blood type, H pylori status, and clinical factors were assessed. Results. Univariate analysis showed no significant differences in genotype frequencies of the COX-1 gene at position -1676 between the peptic ulcer group and control group. Multivariate analysis revealed that blood type O, advanced age, history of peptic ulcer, and concomitant use of NSAID were the independent risk factors for the development of peptic ulcer with the odds ratios of the 2.1, 3.1, 27.6, and 2.9, respectively. Conclusion. The C-1676T polymorphism in the COX-1 gene promoter is not a risk factor for ulcer formation during treatment with low-dose aspirin. Blood type O, advanced age, history of peptic ulcer, and concomitant use of NSAID are of independent significance in predicting peptic ulcer development during treatment with low-dose aspirin.
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Esomeprazole alone compared with esomeprazole plus aspirin for the treatment of aspirin-related peptic ulcers. Am J Gastroenterol 2012; 107:1022-9. [PMID: 22508148 DOI: 10.1038/ajg.2012.87] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Aspirin-related peptic ulcers are a common disorder. However, whether or not aspirin should be continued during treatment for aspirin-related ulcers remains unclear. AIMS To compare esomeprazole alone with esomeprazole plus aspirin in the treatment of aspirin-related peptic ulcers and to investigate the independent factors associated with the failure of ulcer healing. METHODS From January 2008 to July 2011, patients with aspirin-related peptic ulcers were randomized to receive esomeprazole (40 mg per day) alone or esomeprazole (40 mg per day) plus aspirin (100 mg per day) for 8 weeks. The subjects with Helicobacter pylori infection were treated with standard triple therapy. Follow-up endoscopy was carried out at the end of the 8th week. The primary end point was the healing of peptic ulcers. RESULTS In all, 178 patients (89 receiving esomeprazole alone and 89 receiving esomeprazole plus aspirin) were enrolled and underwent follow-up endoscopy. The healing rate of ulcers by modified intention-to-treat analysis was 82.5% (95% confidence interval (CI), 74.2-90.8%) among patients treated with esomeprazole alone and 81.5% (95% CI, 73.0-90.0%) among patients treated with esomeprazole plus aspirin (difference, 1.0%; 95% CI, -11.2 to 12.6%). The per-protocol analysis yielded similar results (healing rate: 83.1% vs. 83.8%, respectively; difference, 0.7%; 95% CI, -11.2 to 12.6%). Multivariate analysis disclosed that use of steroids during treatment (odds ratio: 5.6; 95% CI, 1.1-27.7%) was the only independent factor associated with the failure of ulcer healing. CONCLUSIONS The observed ulcer healing rates were comparable in the esomeprazole and esomeprazole-plus-aspirin groups, but the wide CIs do not rule out clinically meaningful differences of more than 10%.
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Maillard M, Burnier M. Comparative cardiovascular safety of traditional nonsteroidal anti-inflammatory drugs. Expert Opin Drug Saf 2005; 5:83-94. [PMID: 16370958 DOI: 10.1517/14740338.5.1.83] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for their anti-inflammatory and analgesic effects. Unfortunately, these drugs are not without toxicity, namely on the gastric mucosa, but also on the cardiovascular system. In this context, the marketing of the coxibs, a new series of NSAIDs that selectively inhibit COX-2, resulted in a large debate around their cardiovascular safety, because they may increase the incidence of myocardial infarction and stroke. The recent suspension of a large, randomised, controlled trial comparing celecoxib, naproxen and placebo in Alzheimer patients (the ADAPT trial) because of an apparent elevated cardiovascular risk in the naproxen group revived the debate on the cardiovascular safety of these drugs, but this time with special emphasis on the effect of traditional nonselective NSAIDs (tNSAIDs). In this paper that reviews and discusses the cardiovascular safety profile of tNSAIDs, essentially naproxen and ibuprofen in view of the most recent experimental and clinical data, the authors note that the published data are quite discordant and one cannot conclude that there is clear evidence to support a cardiovascular hazard from the administration of naproxen or non-naproxen NSAIDs unless additional information is provided. In addition, the results of retrospective case-control studies have to be interpreted very carefully because of the risk of confounding factors that are not always taken into account when subjects were classified either as cases or controls. Thus, in the absence of clear cut data, physicians will have to use traditional NSAIDs (or coxibs) in patients with a high cardiovascular risk on the basis of their common sense rather than on evidence-based medicine. For these patients, one should not forget that an inadequate long-term control of cardiovascular risk factors such as a hypertension, dyslipidaemia, diabetes, smoking and weight excess is more deleterious in terms of cardiovascular mortality than the administration of NSAIDs itself.
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Affiliation(s)
- Marc Maillard
- Lausanne University Hospital, Service of Nephrology, Department of Internal Medicine, Rue du Bugnon 17, CHUV, 1011 Lausanne, Switzerland
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