title: The effect of COX-2-selective meloxicam on the myocardial, vascular and renal risks: a systematic review.
abstract: OBJECTIVE
  Non-steroidal anti-inflammatory drugs (NSAIDs) are known to increase the risk of cardiovascular (CV) and renal incidences, especially at higher doses and upon long term use. However, the available reports are criticized for lack of specificity, grouping of vastly different outcomes together and ignoring the heterogeneity among NSAIDs. In this systematic review, we are reporting CV/renal risks associated with meloxicam, stratified into myocardial, vascular, renal risk categories, to address the differential nature of NSAIDs effects on different body systems. We are also reporting composite CV/renal risk to present overall risk associated with various covariates.
  
  
  METHODS
  We searched the online healthcare databases for observational studies or randomized controlled trials, reporting myocardial or all-cause mortality outcome (>90 days exposure) and/or vascular/renal outcomes (any exposure) after meloxicam use, published until April 2014. The combined odd ratio values (OR'; 95% CI) were calculated using the random effect inverse variance model.
  
  
  RESULTS
  We found 19 eligible studies out of 2,422 reports. Meloxicam demonstrated a low increase in composite risk (OR' 1.14; CI 1.04-1.25) which was mainly vascular in nature (OR' 1.35; CI 1.18-1.55] as it did not elevate myocardial (OR' 1.13; CI 0.98-1.32) or renal (OR', 0.99; CI 0.72-1.35) risks. Relative to meloxicam, other NSAIDs increased the composite risk, in a dose-dependent fashion, in the following order: rofecoxib > indomethacin > diclofenac > celecoxib > naproxen > ibuprofen. OR' was also influenced by type of disease and the comparator used, and acetylsalicylic acid.
  
  
  CONCLUSIONS
  NSAIDs are heterogeneous in increasing CV/renal risks. The low increased risk associated with meloxicam is mainly vascular in origin.
authors.affiliation: Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, 11361 - 87 Avenue, Edmonton, AB, T6G 2E1, Canada.
authors.forename: Waheed
authors.initials: W
authors.lastname: Asghar
authors.forename: Fakhreddin
authors.initials: F
authors.lastname: Jamali
mesh_terms: D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D016022:Case-Control Studies; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects*; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D000077239:Meloxicam; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012307:Risk Factors; D013843:Thiazines / Q000009:adverse effects*; D013844:Thiazoles / Q000009:adverse effects*; D014652:Vascular Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D013843:Thiazines; D013844:Thiazoles; D000077239:Meloxicam