Study: Sulindac Appears to Reduce Polyps in Some At-Risk Patients

Patients with familial adenomatous polyposis (FAP) who are treated with the nonsteroidal antiinflammatory drug sulindac develop fewer polyps and fewer recurrences of higher-grade rectal adenomas, according to researchers at Johns Hopkins University School of Medicine.

Without treatment, FAP, which is characterized by development of polyps in the colon and rectum, can lead to colorectal cancer.

Researchers studied the long-term effectiveness and toxicity of sulindac in an attempt to ward off the development of adenomas in the retained rectal segment of patients with FAP.

A total of 12 patients with FAP (5 female, 7 male, average age 37) with ileorectal anastomosis were included in the study. Each participant received sulindac (average dose 158/mg/day) for an average of 63 months. Researchers assessed the number, size, and grade of polyps, side-effects, and medication compliance every four months.

Of the 12 participants, 7 remained in the study (6 of them polyp-free) for an average of 77 months. The other 5 patients withdrew from the study after an average follow up period of 44 months. Six patients experienced rectal mucosal erosions, a side effect of the drug.

Researchers reported in the journal Gastroenterologyn that they observed a significant regression of polyps in all patients at 12 months and at an average of 63 months. Researchers also found that sulindac prevented the recurrence of higher-grade adenomas. At 35 months, 1 patients developed stage III rectal cancer.

"Long-term use of sulindac seems to be effective in reducing polyp number and preventing recurrence of higher-grade adenomas in the retained rectal segment of most FAP patients," concluded the researchers. However, erosions at the ileorectal anastomosis site can prevent a patient from receiving adequate dosing of the drug.

Other Sources: Gastroenterology