Does ursodiol lower the risk of colon adenomas or cancer in adults with ulcerative colitis and primary sclerosing cholangitis?

Details

People with both ulcerative colitis (UC) and primary sclerosing cholangitis (PSC) have an elevated risk of colon cancer. Approaches used to reduce colon cancer occurrence in these patients range from surveillance colonoscopy to chemoprevention. Ursodiol had shown some promise as a chemopreventive agent, but results had varied and trials had been small. This meta-analysis therefore compared ursodiol’s efficacy in preventing colonic neoplasia in patients with UC and PSC.

The researchers searched MEDLINE, the Cochrane Central Register of Controlled Trials & Database of Systematic Reviews, CINAHL, PubMed, and recent abstracts from major conferences; the abstract gives the search date as “4/11.” Eligible studies compared ursodiol with no ursodiol or placebo in adults with both UC and PSC. Two independent reviewers extracted data using standard forms. The meta-analysis calculated pooled odds ratios (ORs) for adenoma or colon cancer formation using a random effects model. Heterogeneity was assessed using the I2 measure of inconsistency. Statistical analysis used RevMan 5.1.

Four studies, with a total of 281 participants, met the inclusion criteria. Although there was a trend toward improvement, ursodiol did not show an overall statistically significant reduction in adenoma occurrence (OR 0.53; 95% CI: 0.19–1.48; p=0.23) or colon cancer occurrence (OR 0.50; 95% CI: 0.18–1.43; p=0.20) compared with no ursodiol or placebo in patients with UC and PSC.

The authors concluded that ursodiol use in patients with UC and PSC does not appear to significantly decrease the risk of adenomas or colon cancer. Further randomized controlled trials are required to fully investigate ursodiol use in this patient group.