NSAID, Aspirin Exposure Found to Lower Cancer, Mortality Risk in Patients With Liver Disease

Originally published by our sister publication Gastroenterology & Endoscopy News

BOSTON—Therapeutic exposure to aspirin and nonsteroidal anti-inflammatory drugs is associated with a lower risk for cancer, including liver cancer, and decreased mortality risk in people with liver disease, according to new research.

To investigate the effect of exposure to aspirin and NSAIDs in patients with chronic liver disease, researchers from the Karolinska Institutet in Sweden conducted a population-based cohort study of patients who had been hospitalized in Stockholm between 2005 and 2020 (abstract 3521-C). The mean age at diagnosis was lowest (49 years) for those with viral hepatitis and oldest (66 years) for those with primary cholangitis. Of the 21,439 patients included in the study, 6,756 were exposed to NSAIDs and 4,206 were exposed to aspirin—specifically, prescribed baby aspirin. Over the course of the 15-year study, 10,279 patients died.

After adjusting for comorbidities and disease severity, patients exposed to NSAIDs had a reduced risk for death (adjusted hazard ratio [aHR], 0.68; 95% CI, 0.64-0.72; P<0.001), as did those exposed to aspirin (aHR, 0.86; 95% CI, 0.82-0.91; P<0.001). The risk reductions were similar to those seen with exposure to immunomodulators (aHR, 0.71; 95% CI, 0.65-0.79; P<0.001) and antiviral agents (aHR, 0.70; 95% CI, 0.65-0.76; P<0.001). Exposure to aspirin and NSAIDs was associated with lowered risk for all cancers (aspirin: aHR, 0.68; 95% CI, 0.63-0.73; NSAIDs: aHR, 0.80; 95% CI, 0.75-0.86; P<0.001 for both) and specifically liver cancer (aspirin: aHR, 0.48; 95% CI, 0.41-0.57; NSAIDs: aHR, 0.71; 95% CI, 0.62-0.82;, P<0.001 for both).

“We found that patients exposed to baby aspirin—about 4,000 patients—had a 10% lower mortality,” said lead researcher Knut Stokkeland, MD, PhD, a resident physician in psychiatry at the Stockholm Center for Dependence Disorders and researcher in the Department of Clinical Neuroscience at the Karolinska Institutet. “What was more surprising was that we found the mortality risk for patients prescribed NSAIDs was even lower.”

Dr. Stokkeland said that while the association with mortality has been shown in previous studies, the relationship between the drugs and cancer risk is novel. “It’s been shown that baby aspirin and NSAIDs have an effect on mortality on patients with liver disease. What’s new in this study is that patients had a lower hazard ratio of any form of cancer. The largest effect we see is in patients exposed to baby aspirin. Risk of any cancer is reduced half when you’re exposed to aspirin compared to when you’re not exposed to aspirin.” 

The study’s strengths included near 100% follow-up on all patients over the 15-year period, as well as the high-quality patient data from the Swedish National Patient Register that makes it possible to know how patients are being prescribed medication and what medications they’ve collected from the pharmacy.

Dr. Stokkeland acknowledged that there could be confounding factors in this patient population. “But we adjusted for liver disease severity by adjusting for the MELD [Model for End-stage Liver Disease] score and adjusting for comorbidities using the Charleston Comorbidity Index,” he said.

He cautioned that it is too early to recommend aspirin or NSAIDs to patients with chronic liver disease, and said future studies should aim to identify patients who could benefit from these drugs to prevent cancer and liver disease progression and those who have an increased risk for severe complications. “Despite the limitations of this study,” he said, “I think physicians who see patients with liver disease on these drugs should consider continuing the drug in absence of risk factors.”

—Monica J. Smith