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Many commonly available nutritional supplements and pharmacological agents have been studied as chemoprevention agents for colorectal cancer in people with previous colorectal neoplasia, with variable efficacy in randomized controlled trials.9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Meta analyses have suggested that aspirin and non aspirin non steroidal anti inflammatory drugs (NSAIDs) could be effective in decreasing the risk of advanced metachronous neoplasia (that is, occurring at different times after resection of initial neoplasia),24 25 26 but in the absence of head to head trials, their relative efficacy and safety are not known. Pairwise meta analyses provide only partial information in this case because they can answer questions only about pairs of treatments and do not therefore optimally inform decision making. Network meta analyses combine direct and indirect evidence to establish comparative efficacy and safety across a network of randomized controlled trials of all agents used in a particular condition; such an analysis assumes the trials are conceptually similar with regard to design, participants, intervention (dosing, duration), co interventions, and outcome assessment.27 28 This technique can improve the precision of the estimate (compared with direct evidence alone) and also allows estimation of the comparative efficacy of two active treatments pandora rings, even if no studies directly compare them.29 Such comparisons with a quantitative synthesis of risks and benefits of all candidate chemopreventive agents can inform patients, clinicians, policymakers, and other stakeholders regarding the optimal use of these agents in clinical practice..

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