Safety of meloxicam in aspirin-hypersensitive patients with asthma and/or nasal polyps: A challenge-proven study


BAVBEK S., Dursun A. B. , Dursun E., Eryilmaz A., Misirligil Z.

International Archives of Allergy and Immunology, vol.142, no.1, pp.64-69, 2006 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 142 Issue: 1
  • Publication Date: 2006
  • Doi Number: 10.1159/000096000
  • Journal Name: International Archives of Allergy and Immunology
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.64-69
  • Keywords: aspirin hypersensitivity, aspirin provocation test, asthma, meloxicam, nasal polyposis, COX-2 INHIBITORS, CYCLOOXYGENASE-2 INHIBITOR, SENSITIVE PATIENTS, TOLERABILITY, ROFECOXIB, ATOPY, NIMESULIDE, URTICARIA, DIAGNOSIS
  • Lokman Hekim University Affiliated: No

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 PD 20 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. Copyright © 2007 S. Karger AG.