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Clinical question
Is meloxicam (Mobic) as safe as other non-steroidal anti-inflammatory
medications?
Bottom line
Short-term use of meloxicam at the 7.5 mg daily dose is less likely than
piroxicam, diclofenac, or naproxen to be associated with serious
gastrointestinal complications. However, the absolute risk differences are
less than 1%. Meloxicam has not been shown to be associated with heart
attacks and strokes. A direct comparison with ibuprofen is needed. (LOE =
1a)
Reference
Singh G, Lanes S, Triadafilopoulos G. Risk of serious upper gastrointestinal
and cardiovascular thromboembolic complications with meloxicam. Am J Med
2004; 117:100-06.
Study design: Meta-analysis (randomized controlled trials)
Setting: Various (meta-analysis)
Synopsis
Meloxicam (Mobic) is a non-steroidal anti-inflammatory medication that
preferentially inhibits the COX-2 receptor. These authors pooled data from
28 published and unpublished trials including a total of 24,196 patients to
assess safety profile. Most trials were for 60 days or less, and compared
meloxicam 7.5 mg or 15 mg per day (n = 13,118) with diclofenac (Voltaren)
100-150 mg per day (n = 5464), piroxicam (Feldene) 20 mg per day (n = 5371),
or naproxen 500 mg twice daily (n = 243). Serious gastrointestinal
complications included gastric or duodenal perforation, gastric outlet
obstruction, and hemodynamically important gastrointestinal bleeding.
Thromboembolic events included myocardial infarction and stroke, but not
deep venous thrombosis or pulmonary embolism. The investigators who judged
whether adverse events met the definitions used in this study were blinded
to treatment allocation. There were 54 serious gastrointestinal events that
occurred in less than 1% of any treatment group. So, all numbers needed to
treat to harm (NNTH) will be higher than 100. Significantly fewer
gastrointestinal events were seen with the 7.5 mg dose of meloxicam compared
with each of the other non-steroidals. At the 15 mg dose, the risk with
meloxicam was significantly less only than with piroxicam. Thromboembolic
events were less frequent with either dose of meloxicam than with diclofenac
(NNTH = 720; 95% CI, 320-5717). There were no differences in risk for
cardiovascular events seen with meloxicam compared with piroxicam or
naproxen, with trends favoring meloxicam. |