Safety of Meloxicam in Aspirin-Hypersensitive Patients with Asthma and/or Nasal Polyps

Abstract

Background: The anti-inflammatory actions of acetylsalicylic acid (ASA)/non-steroidal anti-inflammatory drugs (NSAIDs) are thought to be due to inhibition of COX-2, whereas the side effects such as gastric damage and aspirin-induced asthma are mediated through inhibition of COX-1. Therefore, a new class of drugs with COX-2 selectivity may be well tolerated by patients with ASA/NSAIDs hypersensitivity. Objective: We investigated whether subjects with asthma and/or nasal polyps (NP) and analgesic intolerance proven by oral ASA provocation test tolerated the selective COX-2 inhibitor, meloxicam. Methods: All subjects were first challenged with ASA using a 2-day, single-blind, placebo-controlled oral provocation test. Thereafter, the subjects showing positive response to ASA provocation underwent a single-blind, placebo-controlled challenge with a cumulative dose of 7.5 mg of meloxicam on 2 separate days. One and three fourths of the divided doses of placebo and the active drug were given at 1-hour intervals. Clinical symptoms, lung function, and blood pressure were monitored during these challenge protocols. Results: Twenty-one patients with asthma and/or NP (10 males and 11 females; mean age: 38.4 ± 2.9 years) who reacted to ASA challenges were enrolled in the study. Response to ASA provocation was rhinitis + bronchospasm in 13, and extrabronchial reactions in 8 (isolated rhinitis in 3) patients. Mean PD₂₀ was 163.4 ± 39.9 mg ASA among patients who reacted with bronchospasm to ASA. Only 1 patient reacted to meloxicam challenge at a cumulative dose of 7.5 mg. Conclusion: This study indicates that 7.5 mg of meloxicam is a safe alternative treatment for ASA-hypersensitive asthma and/or NP patients with proven hypersensitivity via oral ASA challenges.

Prevalence of aspirin-exacerbated respiratory disease in patients with asthma in Turkey: A cross-sectional survey

“…COX-2 inhibitors are generally considered safe in AERD, but some cutaneous and systemic reactions have been reported with them. 28,29 In our trial a few (5%) AERD patients had a history of reaction to COX-2 inhibitors; unfortunately we do not have data about the type of reaction to these drugs.…”

Mechanisms of Aspirin-Sensitive Respiratory Disease – A Two-Compartment Model

“…COX-2 inhibitors may therefore be safer to use in patients with ASRD than acetaminophen which cross-reacts with aspirin in 20–30% of the aspirin-sensitive patients. The paper by Bavbek et al [26] published in this issue further confirms the relative safety of meloxicam in patients with ASRD. Twenty-one patients with ASRD were challenged with meloxicam.…”

Tolerability to nabumetone and meloxicam in patients with nonsteroidal anti-inflammatory drug intolerance

“…6,[20][21][22][23][24][25][26][27] Most of them reached a 7.5 mg dose, but Gala and Fernández 28 reported a 100% tolerance to meloxicam in 20 NSAID-intolerant patients, reaching a dosage of 22.5 mg. Only 2 of these patients had asthma, and 8 of them were diagnosed with rhinitis. Therefore, our study confirms a high tolerability to higher doses of meloxicam (15 mg) in a large group of patients, including cutaneous/mucous and respiratory NSAID-intolerant subjects.…”