OBJECTIVES: The aim of this study was to compare the preventive effect on adenoma progression of non-steroidal anti-inflammatory drugs (NSAIDs) among patients with familial adenomatous polyposis (FAP).

METHODS: A comprehensive literature search was performed from Pubmed, Embase and Clinical-Trials.gov. 'Familial adenomatous polyposis', ‘non steroid antiinflammatory drug’ and ‘randomized controlled trial’ were used as search key words and percentage change from baseline in polyps number and size were regarded as efficacy indicators. Network meta analysis (NMA) was conducted to estimate the indirect comparisons among NSAIDs based on frequentist framework with contrast-based model. Treatment rank was presented by the surface under cumulative ranking curve (SUCRA). The larger SUCRA, the higher likelihood that an intervention with the better efficacy.

RESULTS: In terms of polyp number, treatment with sulindac produced more reduction percentage than other NSAIDs (compared to Aspirin, percentage difference =-102.30%, 95% CI (-129.18%,-75.42%), compared to high dose celecoxib, percentage difference = -101.50%, 95% CI (-125.60%, -77.40%), compared to low dose celecoxib, percentage difference =-117.60%, 95% CI (-141.73%, -93.47%)).Regarding the SUCRA ranking, sulindac was associated with the best ranking for polyp number reduction (SUCRA=100%), followed by high dose celecoxib (63.4%), aspirin(61.4%), low dose celecoxib (25.2%) and placebo (5%). In terms of polyp size, sulindac also produced noticeable reduction rate than others (compared to Aspirin:percentage difference = -61.45%, 95% CI (-73.14%, -49.16%), compared to high dose celecoxib, percentage difference =-49.20%, 95% CI (-56.96%, -41.44%), compared to low dose celecoxib: percentage difference= -65.30%, 95% CI (73.16%, -57.44%)). The probability of sulindac had the highest SUCRA (SUCRA=100%) in reduction of polyp size, followed by high dose celecoxib (SUCRA=74.8%), aspirin(SUCRA=44.6%), low dose celecoxib (SUCRA=30.6%) and placebo (SUCRA =1%).

CONCLUSIONS: Our NMA results revealed that sulindac had better efficacy in polyps burden control and provided better preventive effect of tumor development.