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Long term treatment with meloxicam in cats

Gowan RA, Baral RM, Lingard AE, et al. A retrospective analysis of the effects of meloxicam on the longevity of aged cats with and without overt chronic kidney disease. J Feline Med Surg. 2012; 14: 876-81.

Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed pharmaceuticals for the treatment of pain and inflammation in humans, dogs, and horses. Meloxicam is metabolized primarily through the oxidative pathway rather than the glucuronidation pathway, an important factor in limiting toxicity in cats. The dependence of many NSAIDs on the glucuronidation pathway is part of the reason for the cat’s susceptibility to NSAID toxicity. Meloxicam is a COX-2 selective inhibitor with a COX-1/COX-2 ratio of inhibition of 2.7; thus, adverse effects of meloxicam are still of concern and primarily involve the gastrointestinal tract and kidneys due to the dependence of these organs on COX-1 for health. In the European Union, Switzerland, Australia, and New Zealand, meloxicam is licensed for long-term treatment of chronic pain in cats. In the United States, meloxicam has a black box label for avoiding its repeated use due to an increased risk of acute renal failure and death. This unacceptable risk has not been a concern in other countries, possibly due to better patient selection and the lower doses used. Regardless of licensed or extra-label use of meloxicam, previous studies have shown that it can be administered safely to aged cats with or without chronic kidney disease (CKD), at least at low therapeutic doses and provided they are clinically stable and monitored carefully.

This study builds on previous work of Gunew et al. and Gowan et al. and further examines the effect of long-term meloxicam administration on renal function in cats with and without pre-existing CKD by providing long-term survival data. A total of 82 cats were enrolled in the study of which 47 had CKD and 35 did not have evidence of overt CKD. Treatment with meloxicam did not appear to decrease longevity in cats with pre-existing CKD, as survival times (median 1608 days) were not reduced when compared with previously published data. Quality of life is a major concern for cat owners, in particular with regard to chronic painful conditions. In conclusion, these authors recommend that meloxicam should be considered as part of a therapeutic regimen in cats with chronic painful conditions, with or without overt stable CKD. [GO]

See also:
Sparkes AH, Heiene R, Lascelles BDX, et al. ISFM and AAFP consensus guidelines: Long-term use of NSAIDs in cats. J Feline Med Surg. 2010; 12: 521-38.

Gowan RA, Lingard AE, Johnston L, Stansen W, Brown SA and Malik R. Retrospective case-control study of the effects of long-term dosing with meloxicam on renal function in aged cats with degenerative joint disease. J Feline Med Surg. 2011; 13: 752-61