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Robenacoxib for acute musculoskeletal pain control in cats

Clinical Scenario

Bert is a 3 year old male neutered domestic shorthaired cat, who has just been presented to you limping and exhibiting signs of pain relating to his left back leg. There are no other injuries and you can’t identify a reason for the pain on clinical exam. You want to administer an NSAID and the practice has recently started stocking robenacoxib. You wonder if there is any evidence to suggest that robenacoxib is better than other NSAIDs at controlling acute musculoskeletal pain in cats...

3-Part Question (PICO)

In [cats with acute musculoskeletal pain] does [robenacoxib compared to other NSAIDs] [provide better pain relief]?

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

(cat.mp. OR cats.mp. OR feline.mp. OR felines.mp. OR felis.mp. OR exp cats/)

AND

(musculoskeletal pain.mp. OR musculoskeletal injury.mp. OR orthopedic pain.mp. OR orthopedic injury.mp. OR orthopaedic pain.mp. OR orthopaedic injury.mp. OR muscular pain.mp. OR muscular injury.mp. OR lame*.mp. OR acute pain.mp. OR limp*.mp. OR exp Lameness, Animal/ OR exp Musculoskeletal Pain/ OR exp Acute Pain/)

AND

(NSAID.mp. OR NSAIDs.mp. OR non steroidal.mp. OR nonsteroidal.mp. OR robenacoxib.mp. OR onsior.mp. OR exp Anti-Inflammatory Agents, Non-Steroidal/)

CAB Abstracts 1910 to Present using the OVID interface

(cat.mp. OR cats.mp. OR feline.mp. OR felines.mp. OR felis.mp. OR exp cats/)

AND

(musculoskeletal pain.mp. OR musculoskeletal injury.mp. OR orthopedic pain.mp. OR orthopedic injury.mp. OR orthopaedic pain.mp. OR orthopaedic injury.mp. OR muscular pain.mp. OR muscular injury.mp. OR lame*.mp. OR acute pain.mp. OR limp*.mp. OR exp lameness/)

AND

(NSAID.mp. OR NSAIDs.mp. OR non steroidal.mp. OR nonsteroidal.mp. OR robenacoxib.mp. OR onsior.mp. OR exp non-steroidal antiinflammatory agents/)

Search Outcome

MEDLINE

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

CAB Abstracts

  • 49 papers found in CAB search
  • 25 papers excluded as they don't meet the PICO question
  • 0 papers excluded as they are in a foreign language
  • 22 papers excluded as they are review articles/in vitro research/conference proceedings
  • 2 total relevant papers from CAB

Total relevant papers

2 relevant papers from both MEDLINE and CAB Abstracts

Summary of Evidence

Giraudel et al (2010) France/UK

Title:

Evaluation of orally administered robenacoxib versus ketoprofen for treatment of acute pain and inflammation associated with musculoskeletal disorders in cats

Patient group:

155 cats with pain and inflammation associated with acute musculoskeletal disorders. There were 3 groups of cats within the study Group 1: 1-2.4mg/kg robenacoxib q24 hrs (56 cats)
Group 2: 1-2.4mg/kg robenacoxib q12 hrs (51 cats)
Group 3: 1mg/kg ketoprofen q24 hrs (48 cats)

Study Type:

Randomised controlled trial

Outcomes:

Clinician assessments performed on days 0, 2 and 4/5:

  • Pain on palpation/mobilization of the affected area (scale of 0-3 with 0 being least painful)
  • Inflammation intensity (scale of 0-3)
  • Mobility (scale of 0-3)
  • Global assessment score (combination of the three scores above, primary outcome)
  • Overall response to treatment compared with day zero

Owner assessments performed daily:

  • Level of activity
  • Appetite
  • Behaviour
  • Human/animal relationship assessed by owner

 Other outcomes:

  • Adverse events
  • Haematology and biochemistry
  • Palatability (owner assessed)
Key Results:
  • Non inferiority of both robenacoxib groups compared to the ketoprofen group was shown for the primary efficacy outcome of global assessment score (quotient 1.004, 95% confidence interval 0.955-1.056, p=0.87 for robenacoxib q24hrs; quotient 1.018, 95% confidence interval 0.968-1.072, p=0.48 for robenacoxib q12hrs).
  • Non inferiority of both robenacoxib groups compared to the ketoprofen group also shown for pain on palpation/mobilisation, inflammation intensity, mobility and overall response to treatment (lower confidence limit >0.8).
  • Non inferiority of both robenacoxib groups compared to the ketoprofen group was shown for the owner assessed outcomes of activity, appetite, behaviour and human/animal relationship (lower confidence limit >0.8).
  • Owner assessed palatability was good/excellent for 66% of group 1, 62% of group 2 and 44% of group 3. Palatability was statistically significantly better for group 1 compared to group 3 (p=0.031) but not different for group 2 compared to group 3 (p=0.083).
  • Adverse events were reported in 18% of cats in group 1, 22% in group 2 and 17% in group 3 - this was not statistically significantly different between groups (p>0.6). The commonest adverse events reported were diarrhea and emesis.
  • No significant differences were found between treatment groups in any of the haematologic values examined.
  • No significant differences were found between treatment groups in any of the biochemical variables examined except for plasma sodium concentration (significantly higher in group 2 compared to groups 1 and 3).
Study Weaknesses:
  • No sample size calculation provided, although this was discussed
  • Owners not blinded to treatment groups
  • No description of the validation of scoring systems used
  • No description given of the 4 cats that had major protocol deviations 
  • Palatability not fully described as a pre-defined outcome in the materials and methods, although it does appear in the appendices
  • Study conducted by Novartis Animal Health (makers of Onsior)
Attachment:
Evidence appraisalEvidence appraisal

Sano et al (2012) Japan

Title:

Comparison of oral robenacoxib and ketoprofen for the treatment of acute pain and inflammation associated with musculoskeletal disorders in cats: A randomised clinical trial.

Patient group:

68 cats with pain and inflammation associated with acute musculoskeletal disorders

Group 1: 1-2mg/kg robenacoxib once daily (47 cats)

Group 2: 1mg/kg ketoprofen once daily (21 cats)

2 cats from the randomised robenacoxib group were excluded for violation of pre-admission exclusion criteria.

Study Type:

Randomised controlled trial

Outcomes:

Clinician assessments performed on days 0, 2 and 4 and at withdrawal:

  • Pain on palpation/mobilization of the affected area (scale of 0-3 with 0 being least painful)
  • Inflammation intensity (scale of 0-3)
  • Mobility (scale of 0-3)
  • Total clinician score (combination of the three scores above, primary outcome)
  • Overall response to treatment

 

Owner assessments performed daily:

  • Activity
  • Appetite
  • Behaviour
  • Human/animal relationship
  • Total owner score

 

  • Adverse events
  • Haematology and biochemistry
Key Results:
  • Non inferiority of robenacoxib to ketoprofen was shown for the total clinician score, overall response to treatment, pain on palpation/mobilisation, mobility and intensity of inflammation (lower confidence interval limit >75%)
  • Non inferiority of robenacoxib to ketoprofen was also shown for owner assessed activity, human/animal relationship and total owner score (lower confidence interval limit >75%) but not for owner assessed appetite and behaviour (lower confidence interval limit <75%)
  • There was no statistically significant difference in the number of adverse events in the robenacoxib group compared to the ketoprofen group. There was 1 case of emesis (2%) in the robenacoxib group vs 2 cases of emesis (10%) in the ketoprofen group (p=0.22).
  • There were no significant changes from baseline in any group for any of the haematologic or biochemical variables examined.
Study Weaknesses:
  • No sample size calculation
  • Owners not blinded to treatment groups
  • No description of the validation of scoring systems used 
  • No discussion of the outcomes that were not reported to be non inferior for robenacoxib (owner assessed behaviour and appetite)
Attachment:
Evidence appraisalEvidence appraisal

Comments

The only studies found to answer this question compared robenacoxib to ketoprofen, no comparisons to other NSAIDs could be found relating to acute musculoskeletal pain in cats. Studies relating to post-operative pain in cats have not been included in this BET.

Bottom line

Robenacoxib has non-inferior (equivalent) efficacy compared to ketoprofen in controlling acute musculoskeletal pain in cats.

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

Giraudel JM, Gruet P, Alexander DG, Seewald W, King JN, (2010). Evaluation of orally administered robenacoxib versus ketoprofen for treatment of acute pain and inflammation associated with musculoskeletal disorders in cats. Amercan Journal of Veterinary Research 71: 710-19.

Sano T, King JN, Seewald W, Sakakibara N, Okumura M, (2012). Comparison of oral robenacoxib and ketoprofen for the treatment of acute pain and inflammation associated with musculoskeletal disorders in cats: A randomised clinical trial. The Veterinary Journal 193:397-403.

About this BET

First author:
Kathryn Wareham
Second author:
Hannah Doit
Institution:

CEVM, University of Nottingham

Search last performed:
2016-08-22 19:38:22
Original publication date:
2016-10-28 19:38:22
Last updated:
2016-10-25 19:38:22
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