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Dogs with osteoarthritis- can you reduce the dose of meloxicam?

Clinical Scenario

During afternoon consultations, Mrs Harper brings Molly the labrador to see you for her regular arthritis check up. At the end of the consultation you ask Mrs Harper if she needs more meloxicam dispensing. Mrs Harper assures you that she has plenty of meloxicam at home, as she no longer gives Molly the full dose every day. She has reduced Molly's dose to around two thirds of the prescribed dose, only giving the full dose when she has a "bad day". You wonder if reducing the dose in this way will mean that Molly is in pain....

3-Part Question (PICO)

In [dogs with osteoarthritis] does [reducing the dose of meloxicam compared to maintaining at the indicated dose of 0.1mg/kg daily] [increase the pain associated with osteoarthritis]?

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$ or canine$ or canis).mp. or exp Dogs/)

AND

((osteoarthriti$ or osteo-arthriti$ or joint Disease$ or djd or oa or arthriti$).mp. or exp Osteoarthritis/ or exp Arthritis/ or exp Joint Diseases/)

AND

(meloxicam.mp. OR metacam.mp. OR non steroidal anti-inflammatory drug$.mp. OR non steroidal anti-inflammatory agent$.mp. OR exp Anti-Inflammatory Agents, Non-Steroidal/ OR non steroidal antiinflammatory drug$.mp. OR non steroidal antiinflammatory agent$.mp. OR non steroidal$.mp. OR NSAID$.mp.)

AND

(dose.mp. OR dosage.mp. OR dosing.mp.)

CAB Abstracts 1910 to Present using the OVID interface

((dog$ or canine$ or canis).mp. or exp dogs/)

AND

((osteoarthriti$ or osteo-arthriti$ or joint Disease$ or djd or oa or arthriti$).mp. or exp osteoarthritis/)

AND

(meloxicam.mp. OR metacam.mp. OR non steroidal anti-inflammatory drug$.mp. OR non steroidal anti-inflammatory agent$.mp. OR non steroidal antiinflammatory drug$.mp. OR non steroidal antiinflammatory agent.mp. OR nonsteroidal.mp. OR NSAID$.mp. OR exp non-steroidal antiinflammatory agents/)

AND

(dose.mp. OR dosage.mp. OR dosing.mp. OR exp dosage/)

Search Outcome

MEDLINE

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

CAB Abstracts

  • 41 papers found in CAB search
  • 39 papers excluded as they don't meet the PICO question
  • 0 papers excluded as they are in a foreign language
  • 1 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

Summary of Evidence

Wernham et al (2011) USA

Title:

Dose reduction of meloxicam in dogs with osteoarthritis-associated pain and impaired mobility

Patient group:

65 client owned dogs with osteoarthritis associated pain and impaired mobility. 

Study Type:

Randomised controlled trial

Outcomes:
  • Number of dogs dropping out because owner deemed pain control insufficient
  • HCPI score (Helsinki Chronic Pain Index)
  • CBPI scores (Canine Brief Pain Inventory)
  • AM counts (Activity Monitor)
  • %BW (Body weight distribution) - the percentage of body weight distribution through each limb over a 5 second period while standing on a pressure sensitive walkway
  • CSOM (Client Specific Outcome Measures) - a selection of activities which were problematic for the dog, unique for each dog, assessed at each visit. 
  • Client records of adverse events
Key Results:
  • Significantly more dogs dropped out of the reduced dose group (RDG) compared to the maintenance dose group (MDG) during the study (13/30 in the RDG versus 6/29 in the MDG, p=0.03).
  • MDG had a significantly slower rate of drop out than the RDG (p=0.035)
  • In the RDG, 26/30 dogs (87%) tolerated at least a 15% reduction in dose
  • For the dogs that remained in the study: overall there were no significant differences between the two groups for CBPI, HCPI, %BW, activity monitoring or CSOM
  • For the dogs that dropped out of the study: there was a significant deterioration in CBPI, HCPI and CSOM (p<0.05) but not in %BW index
  • Adverse events: occurred in 5 dogs, 3 in RDG and 2 in MG. All recovered except 1 which died
Study Weaknesses:
  • Although they calculated that 31 dogs will be needed in each treatment group (total 62 dogs), after 65 dogs enter the study, unfortunately 6 drop out before the first assessment (reported not to be related to pain control). This left 59 dogs for the remainder of the study which makes the sample size too small
  • Some outcomes are measured subjectively e.g. pain scoring
  • Group comparisons for some outcome measures only reported using dogs that did not drop out of the study i.e. comparisons only made between subgroups of dogs in which pain was adequately controlled
Attachment:
No attachments.

Comments

Bottom line

Dose reduction of meloxicam in dogs with osteoarthritis led to significantly increased signs of pain compared to dose maintenance, however dose reduction was tolerated in some dogs.

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

Wernham BGJ, Trumpatori B, Hash J, Lipsett J, Davidson G, Wackerow P, Thomson A, Lascelles BDX (2011). Dose reduction of meloxicam in dogs with osteoarthritis-associated pain and impaired mobility. Journal of Veterinary Internal Medicine 25:1298-1305

About this BET

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

CEVM, University of Nottingham

Search last performed:
2016-02-29 16:33:51
Original publication date:
2016-03-02 16:33:51
Last updated:
2016-02-29 16:33:51
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