SULINDAC INDUCED REGRESSION OF COLORECTAL ADENOMAS IN FAMILIAL ADENOMATOUS POLYPOSIS - EVALUATION OF PREDICTIVE FACTORS

Background-Sulindac, a non-steroidal anti-inflammatory drug, causes re gression of colorectal adenomas in patients with familial adenomatous polyposis (FAP) but the is variable. response Specific clinical factor s predictive of sulindac induced regression have not been studied. Met hods-22 patients with FAP were given sulindac 150 mg orally twice a da y. Polyp number and size were determined before treatment and at three months. The relation of nine clinical factors to polyp regression (pe r cent of baseline polyp number after treatment) was evaluated by univ ariate and multivariate analysis. Results-After three months of sulind ac, polyp number had decreased to 45 per cent of baseline and polyp si ze to 50 per cent of baseline (p<0.001 and p<0.01, respectively). Univ ariate analysis showed greater polyp regression in older patients (p=0 .004), those with previous colectomy and ileorectal anastomosis (p=0.0 01), and patients without identifiable mutation of the APC gem respons ible for FAP (p=0.05). With multivariate regression analysis, response to sulindac treatment was associated with previous subtotal colectomy . Conclusions-Sulindac treatment seems effective in producing regressi on of colorectal adenomas of FAP patients with previous subtotal colec tomy regardless of baseline polyp number and size. Changed sulindac me tabolism, reduced area of the target mucosa, or changed epithelial cha racteristics after ileorectal anastomosis may explain these findings.