Meloxicam is used for anti-inflammatory and analgesic effects in the symptomatic treatment of osteoarthritis or rheumatoid arthritis in adults and for the management of the signs and symptoms of pauciarticular or polyarticular course juvenile rheumatoid arthritis in children 2 years of age or older.
The potential benefits and risks of meloxicam therapy as well as alternative therapies should be considered prior to initiating meloxicam therapy. The lowest possible effective dosage and shortest duration of therapy consistent with treatment goals of the patient should be employed.
Meloxicam is used in the symptomatic treatment of osteoarthritis (OA) in adults. Efficacy for the management of the signs and symptoms of OA (e.g., pain, stiffness, quality of life) of the knee or hip has been established in controlled studies of 4 weeks' to 6 months' duration in adults. Efficacy of 7.5 or 15 mg once daily was comparable to that of piroxicam 20 mg daily or 100 mg daily of conventional or extended-release diclofenac. Meloxicam has not been compared with celecoxib in patients with osteoarthritis.
Rheumatoid Arthritis in Adults
Meloxicam is used for the management of the signs and symptoms of rheumatoid arthritis in adults. In the management of rheumatoid arthritis in adults, NSAIAs may be useful for initial symptomatic treatment; however, NSAIAs do not alter the course of the disease or prevent joint destruction.
Efficacy of meloxicam for the management of rheumatoid arthritis was established in a placebo-controlled, double-blind study of 12 weeks' duration; the primary measure of clinical response in this study was the American College of Rheumatology criteria for a 20% improvement (ACR 20 response) in measures of disease activity. An ACR 20 response is achieved if the patient experiences a 20% improvement in the number of tender and swollen joints and a 20% or greater improvement in at least 3 of the following criteria: patient pain assessment, patient global assessment, physician global assessment, patient self-assessed disability, or laboratory measures of disease activity (i.e., erythrocyte sedimentation rate [ESR] or C-reactive protein [CRP] level). In this study, meloxicam 7.5 or 15 mg daily was substantially more effective than placebo as evaluated by ACR 20 response; the 22. 5-mg daily dosage provided no additional benefit compared with 15 mg daily.
Meloxicam is used for the management of the signs and symptoms of pauciarticular or polyarticular course juvenile rheumatoid arthritis in children 2 years of age or older. Efficacy of meloxicam was established in 2 double-blind, active-controlled studies of 12 weeks' duration; response rates were determined according to the American College of Rheumatology pediatric 30% improvement criteria (ACR pediatric 30; a composite of parent and investigator assessments, number of active joints, number of joints with limited range of motion, disability index, and ESR). Results of these studies indicate that meloxicam is as effective as naproxen in the treatment of juvenile rheumatoid arthritis. In one study, response rates (ACR pediatric 30 criteria) of 77, 76, or 74% were achieved at 12 months in children receiving meloxicam 0.125 mg/kg daily, meloxicam 0.25 mg/kg daily, or naproxen 10 mg/kg daily, respectively.
Meloxicam also has been used in the management of ankylosing spondylitis.