Gastrointestinal safety profile of meloxicam: a meta-analysis and systematic review of randomized controlled trials

Abstract

This article provides a systematic review of the frequency and severity of adverse gastrointestinal (GI) events among patients using meloxicam, a cyclooxygenase (COX)-2–selective nonsteroidal anti-inflammatory drug (NSAID). A MEDLINE search of English language articles from 1990–1998, a manual search of citations from primary trials and review articles, and a manual search of proceedings from international gastroenterology meetings were conducted. Randomized clinical trials comparing the frequency of GI adverse events for meloxicam versus non–COX-2–selective NSAIDs were selected. Specific data about the frequency of dyspepsia; perforations, ulcers, and bleeds (PUBs); and withdrawal of medication because of adverse GI events was also extracted. From a pool of 62 potentially relevant citations, 12 randomized trials were identified. All trials concerning symptomatic GI adverse events used the World Health Organization’s Adverse Reaction Terminology List (WHO-ARTL) to code adverse events. Patients using meloxicam had fewer GI adverse events compared with non–COX-2–selective NSAIDs (odds ratio = 0.64; 95% confidence interval [CI], 0.59–0.69). Patients using meloxicam experienced less dyspepsia (odds ratio = 0.73; 95% CI, 0.64–0.84), fewer PUBs (odds ratio = 0.52; 95% CI, 0.28–0.96), and less frequent discontinuation of NSAID because of adverse GI events (odds ratio = 0.59; 95% CI, 0.52–0.67) compared with non–COX-2 selective NSAIDs. Meloxicam, a COX-2–selective NSAID, appears to cause fewer adverse GI events than standard, non–COX-2–selective NSAIDs. However, the generalizability of these data may be limited by the low dose of meloxicam used in most trials and the use of the WHO-ARTL to code adverse events.