Dogs with osteoarthritis- can you reduce the dose of meloxicam?
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
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/)
((osteoarthriti$ or osteo-arthriti$ or joint Disease$ or djd or oa or arthriti$).mp. or exp Osteoarthritis/ or exp Arthritis/ or exp Joint Diseases/)
(meloxicam.mp. OR metacam.mp. OR non steroidal anti-inflammatory drug$.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$.mp.)
(dose.mp. OR dosage.mp. OR dosing.mp.)
CAB Abstracts 1910 to Present using the OVID interface
((dog$ or canine$ or canis).mp. or exp dogs/)
((osteoarthriti$ or osteo-arthriti$ or joint Disease$ or djd or oa or arthriti$).mp. or exp osteoarthritis/)
(meloxicam.mp. OR metacam.mp. OR non steroidal anti-inflammatory drug$.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/)
(dose.mp. OR dosage.mp. OR dosing.mp. OR exp dosage/)
- 93 papers found in MEDLINE search
- 90 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
- 1 total relevant papers from MEDLINE
- 51 papers found in CAB search
- 46 papers excluded as they don't meet the PICO question
- 0 papers excluded as they are in a foreign language
- 4 papers excluded as they are review articles/in vitro research/conference proceedings
- 1 total relevant papers from CAB
Total relevant papers1 relevant papers from both MEDLINE and CAB Abstracts
The updated search for this BET conducted in February 2018 identified the original version of the BET published in the Veterinary Record (Doit and Wareham, 2016) however no additional primary research was identified.
Summary of Evidence
Wernham et al (2011) USA
Dose reduction of meloxicam in dogs with osteoarthritis-associated pain and impaired mobility
65 client owned dogs with osteoarthritis associated pain and impaired mobility.
Randomised controlled trial
- 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
- 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
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
Doit H, Wareham K (2016) Can you reduce the dose of meloxicam in dogs with osteoarthritis? Veterinary Record 179: 600-601
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
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BETs don’t tell you what to do, they tell you about the evidence on a certain topic.
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