Abstract
PICO question
 In cats with feline interstitial cystitis, which therapy brings a faster resolution of clinical signs: meloxicam or prednisolone?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Two papers evaluated as relevant to the PICO question were critically reviewed. Both were double-blinded randomised controlled trials.
 One paper not related to the PICO question, a single-blinded randomised controlled trial, was also reviewed as it is touched upon in the discussion section
 Strength of evidence
 Appraisal of the literature reveals weak evidence that meloxicam and prednisolone are of equivalent effectiveness when treating feline interstitial cystitis, also known as feline idiopathic cystitis (FIC)
 Outcomes reported
 There is no statistically significant difference in the reduction of clinical signs when meloxicam is compared with a placebo for the treatment of FIC. There is no statistically significant difference in reduction of clinical signs when prednisolone is compared with a placebo for the treatment of FIC. No studies were available for review which directly compared meloxicam against prednisolone as treatment options for FIC
 Conclusion
 In cats with FIC, insufficient evidence exists to truly conclude whether meloxicam or prednisolone is the most efficacious therapy for the reduction of clinical signs. Two double-blinded randomised controlled trials were evaluated – one compared the efficacy of meloxicam against a placebo; the other compared the efficacy of prednisolone against a placebo. Neither study found a statistically significant difference between the assessed treatment modality and the placebo used in reducing the clinical signs of FIC. As such, weak evidence exists that there is no significant difference between the use of meloxicam and a placebo, and prednisolone and a placebo in the reduction of clinical signs of FIC. Additionally, it could therefore be hypothesised that no significant difference exists in the reduction of clinical signs when comparing meloxicam against prednisolone as treatments for FIC however, no study was discoverable which was able to substantiate this claim
 
 How to apply this evidence in practice
 The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
 Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
 
Highlights
Cats presenting with signs of feline lower urinary tract disease (FLUTD) were submitted
The following criteria were applied: o Animals had to have obstructive feline interstitial cystitis (FIC). o Cats with evidence of urolithiasis or neoplasia were excluded. o Those with concurrent disease were excluded. o Cats treated with NSAIDs, antimicrobials or steroids up to 2 weeks before presentation were excluded. o Cats were withdrawn from the study if urine cultures did not return negative at any point throughout the study
While the cat was put through both the treatment and control group, potentially furthering the evidence that there is no significant difference between a placebo and prednisolone this could skew the data as this patient's individual factors have been entered into the study multiple times
Summary
In cats with FIC, insufficient evidence exists to truly conclude whether meloxicam or prednisolone is the most efficacious therapy for the reduction of clinical signs. Weak evidence exists that there is no significant difference between the use of meloxicam and a placebo, and prednisolone and a placebo in the reduction of clinical signs of FIC. It could be hypothesised that no significant difference exists in the reduction of clinical signs when comparing meloxicam against prednisolone as treatments for FIC no study was discoverable which was able to substantiate this claim. The first paper, by Dorsch et al (2016), comparing meloxicam against a placebo, concluded that there was no statistical significance in the reduction of clinical signs when comparing the two study groups. The second paper, by Osborne et al (1996), comparing prednisolone against a placebo, concluded that there was no statistical significance in the reduction of clinical signs when comparing the two study groups
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