From the Guidelines
Meloxicam is the preferred NSAID in patients with inflammatory arthritis associated with immune checkpoint inhibitors, where it can be used at a dose of 7.5-15 mg daily for 4-6 weeks, as recommended by the Society for Immunotherapy of Cancer 1.
Key Considerations
- The choice of meloxicam is based on its efficacy in managing mild pain with inflammatory symptoms, erythema, or joint swelling, as outlined in the guidelines for managing toxicities associated with immune checkpoint inhibitors 1.
- Meloxicam may be particularly suitable for patients who require long-lasting pain relief with once-daily dosing and a potentially lower risk of gastrointestinal side effects compared to traditional NSAIDs.
- However, meloxicam still carries cardiovascular risks similar to other NSAIDs and should be used with caution in patients with heart disease, hypertension, renal impairment, or those taking certain medications like anticoagulants or corticosteroids.
Clinical Context
- The American College of Rheumatology recommends treatment with NSAIDs over no treatment with NSAIDs for adults with active ankylosing spondylitis, but does not recommend any particular NSAID as the preferred choice 1.
- A review article on the prevention of NSAID gastrointestinal complications suggests that NSAIDs with a high analgesic effect and low anti-inflammatory action, such as ibuprofen, may be safer than those with high anti-inflammatory activity, but notes that selective COX-2 inhibitors provide good analgesia with increased safety but at greater expense 1.
Dosage and Administration
- Meloxicam is typically prescribed at 7.5-15 mg once daily for conditions like osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.
- The medication should be taken with food to minimize stomach irritation, and the lowest effective dose should be used for the shortest duration necessary to control symptoms.
From the Research
Circumstances Where Meloxicam is the Preferred NSAID
Meloxicam is considered the preferred NSAID under the following circumstances:
- Osteoarthritis treatment: Meloxicam has been found to be safe and effective in the treatment of osteoarthritis, with a lower incidence of gastrointestinal adverse events compared to other NSAIDs such as diclofenac 2, 3, 4.
- Patients with gastrointestinal issues: Meloxicam's selective inhibition of COX-2 relative to COX-1 makes it a preferable option for patients with gastrointestinal issues, as it has been shown to produce fewer gastrointestinal side effects compared to other NSAIDs 3, 4, 5.
- Patients requiring long-term NSAID treatment: Meloxicam's improved gastrointestinal tolerability profile makes it a suitable option for patients requiring long-term NSAID treatment, reducing the risk of gastrointestinal complications 4, 5.
- Patients with rheumatoid arthritis: Meloxicam has been found to be effective in the treatment of rheumatoid arthritis, with anti-inflammatory effects similar to or better than those of other NSAIDs 5.
Key Benefits of Meloxicam
Some key benefits of meloxicam include:
- Improved gastrointestinal tolerability: Meloxicam has been shown to produce fewer gastrointestinal side effects compared to other NSAIDs, making it a preferable option for patients with gastrointestinal issues 3, 4, 5.
- Effective in osteoarthritis treatment: Meloxicam has been found to be safe and effective in the treatment of osteoarthritis, with a lower incidence of gastrointestinal adverse events compared to other NSAIDs 2, 3, 4.
- Suitable for long-term treatment: Meloxicam's improved gastrointestinal tolerability profile makes it a suitable option for patients requiring long-term NSAID treatment, reducing the risk of gastrointestinal complications 4, 5.