Arthritis Rheum. 2005 Feb 15;53(1):12-7.
Effect of cardiovascular comorbidities and concomitant aspirin
use on selection of cyclooxygenase inhibitor among rheumatologists.
Greenberg JD, Bingham CO 3rd, Abramson SB, Reed G, Sebaldt RJ, Kremer
J.
New York University-Hospital for Joint Diseases, New York, New York,
USA. jeffrey.greenberg@nyumc.org
OBJECTIVE: To evaluate the effects of cardiovascular comorbidities and
aspirin coprescription on cyclooxygenase (COX)-2 inhibitor (coxib) prescribing
patterns among rheumatologists. METHODS: A prospective cohort study was
carried out with rheumatoid arthritis and osteoarthritis patients in the
Consortium of Rheumatology Researchers of North America registry. Medication
and comorbidity data were obtained prospectively from physician and patient
questionnaires between March 2002 and September 2003. Multivariate adjusted
associations between coxib use and specific cardiovascular variables,
including aspirin use, were examined. RESULTS: A total of 3,522 arthritis
patients were included. COX inhibitors, including coxibs, nonselective
nonsteroidal antiinflammatory drugs (NSAIDs), and meloxicam, were prescribed
to a larger proportion of osteoarthritis patients (68.4%) than rheumatoid
arthritis patients (47.1%) in our study (P < 0.001). COX inhibitors
were prescribed to the majority of aspirin users (51.5%) and a similar
proportion of nonusers (49.8%). In multivariate analyses, independent
predictors of coxib use versus nonselective NSAID use included diagnoses
of osteoarthritis (odds ratio [OR] 2.52, 95% confidence interval [95%
CI] 1.81-3.52) and diabetes (OR 1.63, 95% CI 1.06-2.51). Conversely, aspirin
use independently predicted selection of a nonselective NSAID rather than
a coxib (OR 0.73, 95% CI 0.55-0.98). Neither a history of myocardial infarction
nor stroke predicted utilization of a coxib. Similarly, cardiovascular
variables did not predict the use of rofecoxib versus celecoxib. CONCLUSION:
Our data indicate that COX inhibitor coprescription among aspirin users
is frequent. Despite cardiovascular concerns regarding the coxibs, our
data suggest that aspirin use, but not cardiovascular comorbidities, predicted
the selection of nonselective NSAIDs over coxibs.
Klin Med (Mosk). 2004;82(12):54-9.
[Use of meloxicam (movalis) in patients with rheumatic diseases
with concomitant coronary heart disease]
[Article in Russian]
Mazurov VI, Iakusheva VA, Beliaeva IB.
The purpose of the study was to examine the clinical features of the course of coronary heart disease (CHD) in patients with rheumatoid arthritis (RA) and to evaluate the effects of the selective cyclooxygenase-2 (COG-2) inhibitor movalis (meloxicam) in two dosage forms (as injections and tablets) on the course of CHD in this group of patients. The developed questionnaire was used to make a comparative screening survey of 304 patients with RA and 152 patients with osteoarthrosis (OA), who were aged above 40 years. A comprehensive examination of the cardiovascular system was performed in 52 patients with RA concurrent with CHD and 25 patients with OA concurrent with CHD. Angina pectoris on exertion was detected in 37% of the patients with PA and in 35% of the patients with OA. Most (52%) patients with RA and CHD reported rare anginal attacks (once a month) whereas 24-day ECG monitoring revealed myocardial ischemia in 71% of the patients with RA concurrent with CHD; only silent ischemic episodes were recorded in 70% of them. The incidence of silent myocardial ischemia was higher in patients with RA concurrent with CHD than that in those with OA concurrent with CHD (p < 0.03). Examination of the incidence of anginal attacks showed that there was a tendency of the incidence of pains to decrease in patients with RA concurrent with CHD who took selective COG-2 inhibitors. Patients with RA concurrent with CHD who received movalis had atendency of arrhythmia to occur more rarely and of the duration of myocardial ischemia to reduce as compared with those who took nonselective COG-2 inhibitors.
J Int Med Res. 2004 Nov-Dec;32(6):655-64.
Combination treatment using the COX-2 inhibitor meloxicam and
an anti-allergic in pollinosis.
Takechi M.
TSUCHIBASHI SHINRYOSHO (clinic), Honmachi Kochi-city, Kochi, Japan.
lunamac@ps.inforyoma.or.jp
The value of combination therapies that aim to affect both immediate
and delayed inflammatory reactions is well known in the treatment of pollinosis.
Use of a selective cyclooxygenase-2 (COX-2) inhibitor such as meloxicam
is a new approach, however. COX-2 inhibitors target the delayed reaction,
which plays a major role in chronic nature of this allergic reaction through
activation of the arachidonate cascade and the production of prostaglandins.
In this study, four treatment regimens were compared for effectiveness
in relieving the symptoms of pollinosis: (i) an anti-allergic alone; (ii)
an anti-allergic plus a conventional non-steroidal anti-inflammatory drug;
(iii) an anti-allergic plus a selective COX-2 inhibitor; and (iv) an anti-allergic
plus an oral steroid. Use of a COX-2 inhibitor plus an anti-allergic produced
significantly more relief for most symptoms. The significance of this
is as yet unclear, but it is hoped that these results will further our
understanding of chronic inflammation.
Am J Vet Res. 2004 Oct;65(10):1384-90.
Effect of meloxicam and carprofen on renal function when administered
to healthy dogs prior to anesthesia and painful stimulation.
Crandell DE, Mathews KA, Dyson DH.
Department of Clinical Studies, Ontario Veterinary College, University
of Guelph, Guelph, ON, Canada N1G 2W1.
OBJECTIVE: To determine whether administration of the nonsteroidal anti-inflammatory
drugs meloxicam or carprofen to healthy dogs that were subsequently anesthetized
and subjected to painful electrical stimulation has adverse effects on
renal function as measured by glomerular filtration rate (GFR) and evaluation
of serum concentrations of urea and creatinine. ANIMALS: 6 male and 6
female healthy young-adult Beagles. PROCEDURE: A study was conducted in
accordance with a randomized crossover Latin-square design. One of 3 treatments
(saline [0.9% NaCl] solution, 0.2 mg of meloxicam/kg, or 4.0 mg of carprofen/kg)
was administered i.v. 1 hour before anesthesia was induced by use of drugs
in accordance with a standard anesthetic protocol (butorphanol tartrate
and acepromazine maleate as preanesthetic medications, ketamine hydrochloride
and diazepam for induction, and maintenance with isoflurane). Anesthetized
dogs were subjected to intermittent electrical stimulation for 30 minutes.
Direct, mean arterial blood pressure; heart rate; and respiratory rate
were monitored. End-tidal isoflurane concentration was maintained at 1.5
times the minimum alveolar concentration. The GFR, as measured by plasma
clearance of 99mTc-diethylenetriaminepentaacetic acid, and serum concentrations
of serum and creatinine were determined 24 hours after induction of anesthesia.
RESULTS: Neither meloxicam nor carprofen significantly affected GFR or
serum concentrations of urea and creatinine, compared with values for
the saline treatment. CONCLUSIONS AND CLINICAL RELEVANCE: When administered
1 hour before onset of anesthesia and painful electrical stimulation,
meloxicam or carprofen did not cause clinically important alterations
of renal function in young healthy dogs.
Berl Munch Tierarztl Wochenschr. 2004 Jul-Aug;117(7-8):304-9.
Clinical efficacy of meloxicam (Metacam) and flunixin (Finadyne)
as adjuncts to antibacterial treatment of respiratory disease in fattening
cattle.
Friton GM, Cajal C, Ramirez Romero R, Kleemann R.
Boehringer Ingelheim Animal Health GmbH, Ingelheim am Rhein, Germany.
friton@ing.boehringer-ingelheim.com
The clinical efficacy of two non-steroidal anti-inflammatory drugs (NSAIDs),
meloxicam (Metacam 20 mg/ml) and flunixin meglumine (Finadyne), as adjuncts
to antibacterial therapy in the treatment of acute febrile respiratory
disease in cattle was compared. The randomised blind, positive controlled
study was conducted under feedlot conditions in Mexico. Overall, 201 female
cattle (weighing 220-250 kg) diagnosed with bronchopneumonia at the feedlot
were recruited into the study. On Day 0 all animals were treated with
20 mg oxytetracycline/kg body-weight (Bivatop 200) by subcutaneous injection,
in conjunction with either meloxicam (0.5 mg/kg subcutaneously, Metacam
20 mg/ml, n = 100), or flunixin meglumine (2.2 mg/kg intravenously, Finadyne,
n = 101). According to label instructions, meloxicam was administered
as a single dose, whereas flunixin meglumine could be administered daily
for up to 3 consecutive days depending on the rectal temperature (with
re-administration, if rectal temperature > or = 40.0 degrees C). Rectal
temperature, respiratory rate, appetite, dyspnoea, coughing, nasal discharge
and general condition were recorded on Days 0 (prior to treatment), 1,
2, 3 and 7 using a weighted numerical score. Scores were summed to generate
a 'Clinical Sum Score' (CSS, range 7 to 24 points). Individual animal
body weights were measured on Days 0 and 7. Nasal swabs were collected
from 10 animals per treatment group on Day 0 for microbiological culture.
Clinical parameters and the mean CSS showed no significant differences
between treatment groups with mean CSS on Days 0 and 7 of 16.18 and 10.55
in the meloxicam group and 16.41 and 10.88 in the flunixin meglumine group.
However, a significantly lower mean rectal temperature was measured in
the meloxicam group on Day 2 (p < or = 0.01). No significant differences
in mean body weights were found between groups. Repeated administration
of flunixin meglumine was performed in 45% of the animals. No suspected
adverse drug events related to treatments were reported. It is concluded
that a single subcutaneous dose of meloxicam was as clinically effective
as up to 3 consecutive daily intravenous doses of flunixin meglumine when
used as an adjunctive therapy to antibacterial therapy in the treatment
of acute febrile respiratory disease in feedlot cattle.
