Aspirin, eicosapentaenoic acid, and placebo equally effective in preventing colorectal adenomas in high-risk patients

Reference

Hull MA, Sprange K, Hepburn T, et al, for the 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 x 2 factorial trial. Lancet 2018;392(10164):2583-2594.

Synopsis

This study's title is a candidate for the year's most tortured acronym: 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 3 or more adenomas, one of which had to be 1 cm in diameter, OR they had 5 or more smaller adenomas. The researchers randomized patients to receive EPA (1000 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 (9%) patients did not have a follow-up colonoscopy and were excluded from the analysis. The rate of subsequent adenomas at follow-up was high (61%-63%) and not statistically significantly different for each group. The rate of adverse events was low in all groups.