Dose Reduction of Meloxicam in Dogs with Osteoarthritis‐Associated Pain and Impaired Mobility

Abstract

Background: Progressive nonsteroidal anti-inflammatory drug (NSAID) dose reduction appears logical; however, there is no evidence-based medicine indicating that efficacy is maintained as dose is reduced.Objective: To determine if NSAID dose can be reduced and pain relief and mobility can be maintained in dogs with osteoarthritis (OA).Animals: Client-owned dogs (n = 59) with OA-associated impaired mobility and pain. Methods: Prospective, randomized, blinded study. After 14 days wash-out, dogs were randomized to reducing dose (RDG) (n = 30) or maintenance dose (MDG) (n = 29). MDG received standard dose meloxicam. RDG received a reducing dose from D28 onward, reducing to 0% of maintenance for the final 2 weeks. Assessments were at D14, 28, 42, 56, 70, 84, 98 and 112 using subjective owner assessments, accelerometry (AM), and standing percent body weight distribution (%BW). A Kaplan-Meier survival curve described how dogs dropped out because of insufficient pain control. A Log-rank test compared the groups.Results: More dogs in RDG (13) dropped out because of owner-evaluated insufficient pain control compared with MDG (5) (P = .029; odds ratio: 3.67; median dropout time: 84 days in each group). For the dogs that did not drop out (n = 41), there were no significant differences between groups in owner assessments (P > .2 for each), %BW placed on the index limb (P = .750), or accelerometer-measured activity (P = .14).Conclusion and Clinical Relevance: Dose reduction is a less effective means of pain control compared with maintained dosing. However, NSAID dose reduction with maintained efficacy is possible, but success appears to be individual dog dependent.

Mavacoxib and meloxicam for canine osteoarthritis: a randomised clinical comparator trial

“…This represents a fairly modest reduction from the maximum and, as previously stated, a median meloxicam dose reduction of 60 per cent can be achieved before owners consider pain control to be insufficient (Wernham and others 2011). …”

“…One possible reason for this increase in Group M is an increase in meloxicam dosing, especially as ADP was higher for V2 to V3 than for V1 to V2 (albeit by only an average of 0.004 mg/kg/day, 4 per cent of the maximum daily dose). In one study, as measured by percentage of bodyweight distributed to the limb, improvement in limb function of dogs receiving a reducing dose of meloxicam only deviated from those receiving the maximum daily dose when the dose dropped to 40 per cent of maximum (Wernham and others 2011). This, perhaps, makes it unlikely that the 4 per cent (of maximum) average change in dose affected PVF.…”

“…Plasticity of pain transmission pathways and the concept of central sensitisation are described (Kuner 2010), and cyclooxygenase inhibition has reversed aspects of sensitisation in rodents (Telleria-Diaz and others 2010) and experimentally induced hyperalgesia in human beings (Sycha and others 2005). There is moderate evidence that continuous, long-term administration of NSAIDs may have some therapeutic benefits in dogs and people (Luyten and others 2007, Innes and others 2010, Wernham and others 2011). In a multi-centre, 1000-dog study of the safety and effectiveness of firocoxib, veterinarian and owner subjective assessments both improved from baseline to day 10 of treatment, and improved further at day 40 of treatment (Ryan and others 2006); and in another study, more dogs receiving firocoxib improved by 360 days than by day 90 (Autefage and others 2011).…”

“…When compared with animals on maximum meloxicam dose, dogs subjected to a reducing dosing regimen dropped out because of poor pain control, as perceived by the owners, more quickly (Wernham and others 2011). …”

The Challenges of Assessing Osteoarthritis and Postoperative Pain in Dogs

“…An advantage to utilizing such equipment in the assessment of chronic pain in dogs is its potential to objectively evaluate active movement in the home environment, facilitating the generation of reliable mobility information. Osteoarthritis studies have incorporated the use of a small, sensitive, and omnidirectional accelerometer to measure daily activity in dogs (17,98). However, before these quantitative devices can be used in clinical veterinary studies to evaluate analgesics, additional research is needed to assess their performance across breeds and ages of dogs, to establish a correlation between activity and pain, and determine what degree of increased activity translates into a clinically relevant, significant improvement in pain.…”