What is safer for the gastrointestinal-tract: Coxibs or meloxicam?
Are high cyclooxygenase-2 (COX-2) selectivity and the absence of its impact on COX-1 the most important benefit of coxibs? Based on the classical concepts that nonsteroidal anti-inflammatory drugs (NSAIDs) are implicated in the pathogenesis of the most well-known complication -NSAID gastropathy, this must be so. Indeed, the development of gastrointestinal tract (GIT) diseases associated with NSAID use is mainly related to the blockade of COX-1 and to the decreased synthesis of cytoprotective prostaglandins. However, the clinical experience with etoricoxib, one of the most selective coxibs, casts doubt on this fact. There are well-known data of the MEDAL study, which show the equal rate of gastrointestinal bleeding in patients receiving etoricoxib and diclofenac. At the same time, moderately selective NSAIDs that include very popular meloxicam demonstrate a good tolerability and a low risk for GIT complications. A network meta-analysis of 36 studies covering a total of 112,351 patients indicates that there are no significant differences in the incidence of complicated and uncomplicated ulcers in patients receiving coxibs (a group analysis) and moderately selective NSAIDs (meloxicam, nabumetone, and etodolac). It is important that meloxicam demonstrates not only the low total frequency of GIT complications, but a quite moderate (as compared with diclofenac and etoricoxib) risk for cardiovascular and renal complications, which determines its benefit when used in real clinical practice.