The Pharmaceutical Journal
Vol 274 No 7338 p228
26 February 2005

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Meloxicam as safe as some other NSAIDs

POEM series

Clinical question Is meloxicam (Mobic) as safe as other non-steroidal anti-inflammatory drugs?

Bottom line Short-term use of meloxicam at a daily dose of 7.5mg is less likely than piroxicam, diclofenac or naproxen to be associated with serious gastrointestinal complications. However, the absolute risk differences are less than 1 per cent. Meloxicam has not been shown to be associated with heart attacks and strokes. A direct comparison with ibuprofen is needed.

Synopsis Meloxicam (Mobic) is a non-steroidal anti-inflammatory drug (NSAID) that preferentially inhibits the cyclo-oxygenase-2 (COX-2) receptor. These authors pooled data from 28 published and unpublished trials including a total of 24,196 patients to assess meloxicam’s safety profile. Most trials were for 60 days or less and compared meloxicam 7.5mg or 15mg per day (n=13,118) with diclofenac 100–150mg per day (n=5,464), piroxicam 20mg per day (n=5,371) or naproxen 500mg twice daily (n=243). Serious gastrointestinal complications included gastric or duodenal perforation, gastric outlet obstruction, and haemodynamically 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 per cent of any treatment group. So, all numbers needed to harm (NNTH) will be higher than 100. Significantly fewer gastrointestinal events were seen with the 7.5mg dose of meloxicam compared with each of the other NSAIDs. At the 15mg 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 per cent confidence interval 320–5,717). There were no differences in risk for cardiovascular events seen with meloxicam compared with piroxicam or naproxen, with trends favouring meloxicam.

Level of evidence = 1a (systematic review of RCTs, with homogeneity)

Reference Singh G, Lanes S, Triadafilopoulos G. Risk of serious upper gastrointestinal and cardiovascular thromboembolic complications with meloxicam. American Journal of Medicine 2004;117:100–06

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