(P057) DAILY ASPIRIN USE IN ULCERATIVE COLITIS: A DOUBLE-EDGED SWORD INCREASING MORTALITY AND SEVERE OUTCOMES WHILE MODESTLY REDUCING COLORECTAL CANCER RISK

Background 

Inflammation of the colonic mucosa is a hallmark of ulcerative colitis (UC), a chronic inflammatory bowel disease that can cause varied levels of morbidity. Despite being widely utilized for its cardiovascular benefits, aspirin's impact on UC patients' clinical outcomes are still up for discussion. According to some research, aspirin's anti-inflammatory qualities may lower the incidence of colorectal cancer (CRC), but they may also worsen colonic inflammation and raise the chance of serious complications from UC. The purpose of this study is to assess how aspirin use affects important clinical outcomes in patients with ulcerative colitis (UC), such as the risk of toxic megacolon, CRC incidence, all-cause mortality, colectomy rates, and UC exacerbations.

Methods 

This retrospective cohort study utilized the TriNetX database to analyze 107,782 UC patients, comparing aspirin users (n = 53,891) to non-users (n = 53,891), matched 1:1 using propensity score matching based on demographics and clinical variables. Primary outcomes were evaluated using Cox proportional hazards models and Kaplan-Meier survival analysis. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated, and statistical significance was set at p < 0.05.

Results

Aspirin use was associated with a 25% higher risk of all-cause mortality (HR: 1.25, 95% CI: 1.21–1.29, p < 0.001), with mortality rates of 15.7% in aspirin users versus 12.6% in non-users. A modest reduction in colorectal cancer risk was observed in aspirin users (HR: 0.92, 95% CI: 0.85–1.00, p = 0.044), with CRC rates of 2.1% compared to 2.3% in non-users. However, colectomy rates showed no significant difference between the two groups (HR: 1.04, 95% CI: 0.92–1.18, p = 0.52), with incidences of 0.9% in both.

Aspirin use was significantly associated with an increased risk of UC exacerbations (HR: 1.85, 95% CI: 1.79–1.92, p < 0.001), with exacerbation rates of 13.7% in the aspirin group versus 7.4% in non-users. Additionally, aspirin users were at higher risk of developing toxic megacolon (HR: 1.51, 95% CI: 1.26–1.81, p < 0.001), with rates of 0.6% versus 0.4% in non-users.

Conclusion 

While there is a marginally lower risk of colorectal cancer, aspirin use in UC patients is linked to higher risks of toxic megacolon, UC exacerbations, and all-cause death. The idea that aspirin would be generally advantageous in this population is called into question by these results. Clinicians should carefully weigh the risks of severe outcomes against the modest reduction in CRC risk when prescribing aspirin to UC patients, particularly those at higher risk for exacerbations and mortality. Additional prospective research is necessary to validate these relationships and improve overall management of UC, given this study was retrospective in nature.