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Meloxicam versus carprofen in canine osteoarthritis

Clinical Scenario

Sasha is a 12 year old Rough Collie presenting to you with a history of gradual onset stiffness and reluctance to exercise. You perform a clinical examination and find reduced range of movement and pain on manipulation of several limb joints. You follow this up with radiographs to confirm your diagnosis of osteoarthritis. You plan to dispense meloxicam for Sasha, however Sasha's owner mentions that one of his previous dogs was treated for arthritis with carprofen, and he asks whether the meloxicam will be more effective. You wonder whether treatment with meloxicam will show a greater improvement in clinical signs than carprofen...

3-Part Question (PICO)

In [dogs with osteoarthritis] does [meloxicam compared with carprofen] result in [greatest clinical improvement]?

Search Strategy and Summary of Evidence

Search Strategy

MEDLINE(R) In-Process & Other Non-Indexed Citations and MEDLINE(R) 1946 to Present using the OVID interface

(dog.mp. OR dogs.mp. OR canine.mp. OR canines.mp. OR canis.mp. OR exp Dogs/)

AND

(osteoarthritis.mp. OR osteoarthritic.mp. OR joint disease.mp. OR joint diseases.mp. OR DJD.mp. OR OA.mp. OR arthritis.mp. OR arthritic.mp. OR exp Osteoarthritis/)

AND

(carprofen.mp. OR rimadyl.mp. OR canidryl.mp. OR carprodyl.mp. OR rimifin.mp. OR carprieve.mp. OR novox.mp. OR vetprofen.mp. OR non steroidal$.mp. OR nsaid$.mp. OR nonsteroidal$.mp. OR meloxicam.mp. OR loxicom.mp. OR metacam.mp. OR inflacam.mp. OR rheumocam.mp. OR comfortan.mp. OR meloxidyl.mp. OR exp Anti-Inflammatory Agents, Non-Steroidal/)

CAB Abstracts 1910 to Present using the OVID interface

(dog.mp. OR dogs.mp. OR canine.mp. OR canines.mp. OR canis.mp. OR exp dogs/)

AND

(osteoarthritis.mp. OR osteoarthritic.mp. OR joint disease.mp. OR joint diseases.mp. OR DJD.mp. OR OA.mp. OR arthritis.mp. OR arthritic.mp. OR exp osteoarthritis/)

AND

(non steroidal$.mp. OR nsaid$.mp. OR nonsteroidal$.mp. OR carprofen.mp. OR rimadyl.mp. OR canidryl.mp. OR carprodyl.mp. OR rimifin.mp. OR carprieve.mp. OR novox.mp. OR vetprofen.mp. OR meloxicam.mp. OR loxicom.mp. OR metacam.mp. OR inflacam.mp. OR rheumocam.mp. OR comfortan.mp. OR meloxidyl.mp. OR exp non-steroidal antiinflammatory agents/)

Search Outcome

MEDLINE

  • 342 papers found in MEDLINE search
  • 330 papers excluded as they don't meet the PICO question
  • 0 papers excluded as they are in a foreign language
  • 11 papers excluded as they are review articles/in vitro research/conference proceedings
  • 1 total relevant papers from MEDLINE

CAB Abstracts

  • 412 papers found in CAB search
  • 401 papers excluded as they don't meet the PICO question
  • 1 papers excluded as they are in a foreign language
  • 9 papers excluded as they are review articles/in vitro research/conference proceedings
  • 1 total relevant papers from CAB

Total relevant papers

1 relevant papers from both MEDLINE and CAB Abstracts

Comments

Three systematic reviews of canine osteoarthritis treatment were also identified but none directly answered the PICO question and thus were excluded (Aragon et al, 2007; Sanderson et al., 2009; Innes et al., 2010).

Summary of Evidence

Moreau et al., 2003, Canada

Title:

Clinical evaluation of a nutraceutical, carprofen and meloxicam for the treatment of dogs with osteoarthritis

Patient group:

71 client-owned dogs weighing over 20 kg and over 18 months of age with clinical and radiographic evidence of chronic, stable osteoarthritis in (one or both) elbow, stifle or hip joint(s). 

Study Type:

Randomised controlled trial

Outcomes:
  • Subjective owner assessment of activity and pain
  • Subjective veterinary orthopaedic surgeon assessment of lameness, articular mobility and articular pain
  • Objective gait analysis using ground reaction force measurements
  • Biochemistry, haematology and faecal occult blood
Key Results:
  • Dogs receiving carprofen showed no statistically significant response in owner subjective scores as compared to baseline (pretreatment).  In dogs receiving meloxicam, a subgroup with stifle disease (n=6) had statistically significant improved owner scores at day 30 as compared to baseline but not at day 60.
  • Dogs receiving carprofen or meloxicam showed statistically significant improvement in  veterinarian subjective orthopaedic scores relative to baseline at day 30 but not at day 60.
  • Dogs receiving carprofen or meloxicam showed improvements in some selected ground reaction force measures as compared to baseline (pretreatment).

Study Weaknesses:
  • The study was not powered or designed to analyse comparative efficacy; no sample size or power calculation is presented and the data was not analysed using statistical methods to compare response between the groups.

  • Additionally, effect size or confidence intervals were not reported for the comparison between the groups.

  • Baseline characteristics of each treatment group are incompletely reported making comparability difficult to assess.

  • The results are not fully reported for each primary and secondary outcome at each time point for each group.  Summary results giving estimated effect size and precision are not presented with the exception of selected GRF parameters and subgroups.  These omissions preclude meaningful interpretation of clinical effectiveness from each treatment.

Attachment:
Evidence appraisalEvidence appraisal

Comments

The quality of the single study identified is questionable with high risk of bias due to selective reporting and manufacturer sponsorship; the study was funded by Boehringer Ingelheim, manufacturers of Metacam. 

Dosing was appropriate for carprofen and meloxicam but generalizability of results to other dogs with osteoarthritis is uncertain.

Bottom line

There is insufficient evidence to determine whether treatment of osteoarthitis in dogs with meloxicam compared with carprofen results in greater clinical improvement. 

Disclaimer

The BETs on this website are a summary of the evidence found on a topic and are not clinical guidelines. It is the responsibility of the individual veterinary surgeon to ensure appropriate decisions are made based on the specific circumstances of patients under their care, taking into account other factors such as local licensing regulations. Read small print

References

Aragon CL, Hofmeister EH, Budsberg SC, (2007). Systematic review of clinical trials of treatments for osteoarthritis in dogs. Journal of the American Veterinary Medical Association 230: 514–21.

Innes JF, Clayton J, Lascelles BDX, (2010). Review of the safety and efficacy of long-term NSAID use in the treatment of canine osteoarthritis. Veterinary Record 166: 226–30. 

Moreau M, Dupuis J, Bonneau NH, Desnoyers M, (2003). Clinical evaluation of a nutraceutical, carprofen and meloxicam for the treatment of dogs with osteoarthritis. Veterinary Record 152: 323-29.

Sanderson RO, Beata C, Flipo RM, Genevois JP, Macias C, Tacke S, Vezzoni A, Innes JF, (2009). Systematic review of the management of canine osteoarthritis. Veterinary Record 164: 418–24.

About this BET

First author:
Constance White
Second author:
Lisa Morrow
Institution:

Oregon State University Carlson College of Veterinary Medicine

CEVM, University of Nottingham

Search last performed:
2019-12-14 20:19:58
Original publication date:
2019-12-14 20:19:58
Last updated:
2019-12-14 20:19:58
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