Aspirin and NSAIDs are associated with reduced cancer and mortality risk in patients with chronic liver diseases – a Swedish cohort study

Abstract Background and aims: We explored the effect of exposure to anti-inflammatory drugs in patients with chronic liver disease with regard to adverse liver events, cancers and mortality. Methods: A population-based cohort of patients with chronic liver disease 2005-2020 (n=21 439) was studied. All patients were hospitalized in Region Stockholm. Data from the Patient Register, Prescribed Drug Register, Death Certificate Register, Cancer Register, two laboratories and Stockholm Center for Health Data primary care database were combined. We analyzed death, adverse liver events, liver cancers and all cancers in relation to drug exposure. Results: During follow-up 10 279 patients (47.9%) died. There was a reduced risk for all cancers combined when patients were exposed to aspirin (cHR 0.68; 95%CI 0.63-0.73) and NSAIDs (aHR 0.80; 95%CI 0.75-0.86) and a reduced risk of liver cancer in patients exposed to aspirin (aHR 0.48; 95%CI 0.41-0.57) and to NSAIDs (aHR 0.71; 95% CI 0.62-0.82). There was a reduced risk of mortality for all patients exposed to NSAIDs (aHR 0.68; 95%CI 0.64-0.72) and a reduction of mortality risk for patients exposed to aspirin (aHR 0.86; 95%CI 0.82-0.91) after adjusting for comorbidities and severity of the liver disease. Patients with alcohol-associated liver disease exposed to aspirin had reduced mortality risk (aHR 0.82; 95%CI 0.76-0.89) and exposure to NSAIDs also reduced the mortality risk (aHR 0.74; 95%CI 0.69-080). Conclusions: Exposure to aspirin or NSAIDs in patients with chronic liver diseases was associated with reduced cancer risks including the risk for liver cancer and decreased mortality risk.