Tolerability of meloxicam in patients with histories of adverse reactions to nonsteroidal anti-inflammatory drugs

Background: Adverse reactions to nonsteroidal anti-inflammatory drugs (NSAI Ds) are frequent, particularly among patients with chronic urticaria or ast hma. The need to identify an alternative drug that is safe and reliable is a common problem in clinical practice. Objective: To assess the tolerability of meloxicam, a new NSAID that select ively inhibits the inducible isoform of cyclooxygenase, in a group of NSAID -sensitive patients. Patients and Methods: We studied 177 patients who had suffered adverse reac tions to one or more NSAIDs. Cutaneous reactions were reported by 83.1% of the subjects (urticaria in 55, angioedema in 52, urticaria/angioedema in 39 , and maculopapular rash in 1), respiratory symptoms by 3.9%, both cutaneou s and respiratory symptoms by 9%, Stevens-Johnson's syndrome by 2.3%, and a naphylactoid reactions by 1.7%. All subjects underwent a single-blind, plac ebo-controlled oral challenge with divided therapeutic doses of meloxicam ( 1.9 mg + 5.6 mg 1 hour later = cumulative dose 7.5 mg), Results: Positive reactions were observed in only two cases (1.1%), both ma nifested exclusively by cutaneous symptoms (urticaria/angioedema in one cas e and maculopapular rash/facial edema in the second). Conclusion: Meloxicam seems to be well tolerated by NSAID-sensitive subject s whose reactions are manifested by urticaria/angioedema. Additional study is needed for a more complete assessment of its tolerability in patients wi th aspirin-induced asthma and other severe manifestations of NSAID sensitiv ity.