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Meta-Analysis
. 2014 Apr 7;9(4):e94208.
doi: 10.1371/journal.pone.0094208. eCollection 2014.

5-Aminosalicylates reduce the risk of colorectal neoplasia in patients with ulcerative colitis: an updated meta-analysis

Li-Na Zhao  1 , Jie-Yao Li  1 , Tao Yu  1 , Guang-Cheng Chen  1 , Yu-Hong Yuan  1 , Qi-Kui Chen  1
Affiliations
Meta-Analysis

5-Aminosalicylates reduce the risk of colorectal neoplasia in patients with ulcerative colitis: an updated meta-analysis

Li-Na Zhao et al. PLoS One. .

Abstract

Background: Although the chemopreventive effect of 5-aminosalicylates on patients with ulcerative colitis has been extensively studied, the results remain controversial. This updated review included more recent studies and evaluated the effectiveness of 5-aminosalicylates use on colorectal neoplasia prevention in patients with ulcerative colitis.

Methods: Up to July 2013, we searched Medline, Embase, Web of Science, Cochrane CENTRAL, and SinoMed of China for all relevant observational studies (case-control and cohort) about the effect of 5-aminosalicylates on the risk of colorectal neoplasia among patients with ulcerative colitis. The Newcastle-Ottawa Scale was used to assess the quality of studies. Adjusted odds ratios (ORs) were extracted from each study. A random-effects model was used to generate pooled ORs and 95% confidence intervals (95%CI). Publication bias and heterogeneity were assessed.

Results: Seventeen studies containing 1,508 cases of colorectal neoplasia and a total of 20,193 subjects published from 1994 to 2012 were analyzed. 5-aminosalicylates use was associated with a reduced risk of colorectal neoplasia in patients with ulcerative colitis (OR 0.63; 95%CI 0.48-0.84). Pooled OR of a higher average daily dose of 5-aminosalicylates (sulfasalazine ≥ 2.0 g/d, mesalamine ≥ 1.2 g/d) was 0.51 [0.35-0.75]. Pooled OR of 5-aminosalicylates use in patients with extensive ulcerative colitis was 1.00 [0.53-1.89].

Conclusion: Our pooled results indicated that 5-aminosalicylates use was associated with a reduced risk of colorectal neoplasia in patients with ulcerative colitis, especially in the cases with a higher average daily dose of 5-aminosalicylates use. However, the chemopreventive benefit of 5-aminosalicylates use in patients with extensive ulcerative colitis was limited.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flowchart of literature search for meta-analysis.
Figure 2
Figure 2. Forest plot (random-effects model) of 5-ASA use and colorectal neoplasia.
Figure 3
Figure 3. This diagram showed the influence of excluding each study in turn on the primary meta-analysis.
The pooled ORs ranged from 0.60 to 0.68, with all showing statistically significant association between 5-ASA and colorectal neoplasia.
Figure 4
Figure 4. Begg's test and Egger's test.
Begg's test and Egger's test identified no publication bias (Begg's test: Kendall's tau = −12, P = 0.65; Egger's test: bias = −1.36, P = 0.092).
Figure 5
Figure 5. Forest plots of subanalyses of study settings (A) and geographical regions (B).
Figure 6
Figure 6. Forest plots of subanalyses of UC and IBD (A), average daily dose of 5-ASA use (B), and extensive UC (C).
Figure 7
Figure 7. Forest plot of cumulative meta-analysis over time.
See this image and copyright information in PMC

References

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