Celecoxib Reduces the Number of Colorectal Polyps

In the N Eng J Med 342:1946, 2000, Steinbach et al compared the effect of celecoxib (100 or 400 mg, twice daily) to placebo in patients with adenomatous polyposis, an inherited condition that leads to colon cancer. Patients underwent endoscopies before and after six months of therapy to assess size and number of colorectal polyps from photographs and videotapes. After six months, patients receiving 400 mg of celecoxib (n = 30) had a 28% (P = 0.003) reduction in the mean number of colorectal polyps and a 30.7% (P = 0.001) reduction in the sum of polyp diameters, as compared to 4.5% and 4.9%, respectively, in patients receiving placebo. Patients receiving 100 mg celecoxib had an 11.9% (P = 0.33) and 14.6% (P = 0.09) reduction in number and size, respectively.

These data show that 400 mg, twice daily, of celecoxib is associated with significant regression of colorectal adenomas in patients with familial adenomatous polyposis. Whether this will reduce the long-term incidence of colon cancer is not known yet.

Editorial comment: In addition to its role in promoting the pain and inflammation of arthritis, COX-2 also appears to be important in sustaining the growth of tumor cells in the colon. Expanded used of the COX-2 inhibitors is likely to continue to evolve as we continue to explore the role of COX-2 in health and disease.