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Press Releases

Take a look at a selection of our recent media coverage:

Aspirin use associated with improved survival but only for bladder and breast cancer

18th January 2021

The protective effects of aspirin in older patients with a range of different cancers has been poorly studied prompting researchers to examine the benefits for a range of different cancers.

The risk-benefit ratio for the use of aspirin in older adults is still unclear though some secondary analyses of randomised trials have indicated that aspirin can reduce the incidence and mortality due to colorectal cancer. Given this uncertainty, a team from the Division of Cancer Prevention, National Cancer Institute, Maryland, US, decided to focus their investigation on a post hoc analysis of older individuals in the prostate, lung, colorectal and ovarian cancer screening trial (PLCO).

PLCO was a large trial to determine the effects of screening on cancer-related mortality and secondary endpoints in people aged 55 to 74 years of age. The researchers limited their analysis to individuals at least 65 years of age after enrolment and whose baseline questionnaire contained information on aspirin use. Individuals who had a history of any of the cancers studied were excluded. The use of aspirin was then categorised as either less than or more than three-times/week. The aim of the study was to evaluate whether use of aspirin had an impact on the incidence and survival from bladder, breast, oesophageal, gastric, pancreatic and uterine cancers among individuals 65 years of age and older. The original PLCO data collection was completed in 2009 after 13 years of follow-up but for the current study, data collection continued until 2014, among individuals who consented to further follow-up or 2009 in those unwilling to be followed.

Findings
The eligible study population included 139,896 individuals with a mean age at baseline of 66.4 years (51.4% female). A total of 32,580 incident cancers were recorded during the follow-up period. The use of aspirin at least three times per week not associated with the incident risk of any of the included cancers. However, the researchers did find that after adjustment for co-morbidities, aspirin use (i.e., at least three times per week) was associated with a significantly increased survival compared to no use of the drug for bladder (hazard ratio, HR = 0.67, 95% CI 0.51–0.88, p = 0.003) and breast cancer (HR = 0.75, 95% CI 0.59–0.96, p = 0.02) only. In addition, any use of aspirin was also associated with a reduced risk of death from both bladder (HR = 0.75, 95% CI 0.58 – 0.98) and breast cancer (HR = 0.79, 95% CI 0.63–0.99) but again, not for any of the other cancers.

Unfortunately, the authors were unable to account for their findings and concluded that further work is needed to consider the relative benefits and harms associated with longterm use of aspirin.

Citation
Loomans-Kropps HA, Pinksky P, Umar A. Evaluation of aspirin use with cancer incidence and survival among older adults in the prostate, lung, colorectal, and ovarian cancer screening trial. JAMA Netw Open 2021

Ticagrelor and aspirin superior to aspirin alone in ischaemic stroke

20th November 2020

It is known that only a quarter of patients who experience an ischaemic stroke with a disability will improve over time and are at an increased risk of subsequent death.

Thus any intervention that is able to reduce disability by reducing a subsequent ischaemic stroke is a major objective of immediate therapy. Although the use of aspirin in combination with clopidogrel has been shown to reduce the risk of further stroke and myocardial infarction, to date, evidence for a beneficial effect from adding ticagrelor to aspirin in terms of a reduction in the burden of disability after a stroke is lacking.

In an analysis, researchers from the Department of Neurology and Stroke Center, University of Paris, France, sought to examine whether combing both drugs reduced the 30-day risk of disabling stroke or death. Disability was measured using the modified Rankin Scale (mRS) which ranges from 0 to 6, in which 0-1 represents no disability, 2-5 increasing disability and 6, death. Patients were enrolled if they were 40 years of age and older, with a non-cardioembolic acute ischaemic stroke and a stroke scale score of 5 or less (higher scores indicate more severe stroke). They were randomised to ticagrelor or matching placebo 1:1 and a loading dose of 180mg was given as soon as possible after randomisation, followed by a daily dose of 180mg (90mg twice daily). In addition, all patients received 300 to 325 mg of aspirin on the first day, followed by 75 to 100mg until day 30. The main outcome measure was the time to the occurrence of disabling stroke or death within 30 days, measured by the mRS scale.

Findings
A total of 11,016 patients with a mean age of 68.1 years (42.6% female) were included in the study. A primary end point with a mRS > 1 at day 30 (that is. disabling stroke or death) occurred in 221 (4.0%) of patients taking ticagrelor and in 260 (4.7%) of those taking placebo. This provided a number needed to treat of 133. In other words, treating 133 patients with ticagrelor and aspirin for 30 days, avoided 1 disabling stroke or death at day 30. Furthermore, disability burden (based on the mRS scale) was reduced by 23%.

Reference
Amarenco P et al. Ticagrelor added to aspirin in acute ischemic stroke
or transient ischemic attack in prevention of disabling stroke: A randomized clinical trial.
JAMA Neurol doi:10.1001/jamaneurol.2020.4396