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

• Published in: Journal of allergy and clinical immunology Vol. 119; no. 4; pp. 960 - 964
• Main Authors: Prieto, Alicia, De Barrio, Manuel, Martín, Elena, Fernández-Bohórquez, María, de Castro, Francisco Javier, Ruiz, Francisco Javier, Herrero, Teresa, Tornero, Pilar, Rubio, María
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.04.2007; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Allergy and Immunology; Angioedema - drug therapy; Angioedema - enzymology; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Asthma; Asthma - drug therapy; Asthma - enzymology; Biological and medical sciences; Butanones - adverse effects; Butanones - therapeutic use; Cyclooxygenase 1 - metabolism; Cyclooxygenase 2 Inhibitors - therapeutic use; Cyclooxygenase Inhibitors - adverse effects; Cyclooxygenase Inhibitors - therapeutic use; Drug dosages; Drug Resistance, Multiple - immunology; Enzymes; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Immunopathology; Male; Medical sciences; meloxicam; Middle Aged; nabumetone; Nonsteroidal anti-inflammatory drug intolerance; Nonsteroidal anti-inflammatory drugs; Rhinitis - drug therapy; Rhinitis - enzymology; Single-Blind Method; Thiazines - adverse effects; Thiazines - therapeutic use; Thiazoles - adverse effects; Thiazoles - therapeutic use; PEF; meloxicam; SBPCOCT; Nonsteroidal anti-inflammatory drug intolerance; NSAID; nabumetone; Nonsteroidal anti-inflammatory drug; Peak expiratory flow; Single-blind placebo-controlled oral challenge test; Human; Meloxicam; Immunopathology; Prostaglandin-endoperoxide synthase; Oxicam derivatives; Enzyme; Enzyme inhibitor; Cyclooxygenase 2 inhibitor; Non steroidal antiinflammatory agent; Nabumetone; Intolerance; Immunology; Oxidoreductases
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2006.12.616

Because nonsteroidal anti-inflammatory drug (NSAID) intolerance depends on COX-1 inhibition, preferential or selective COX-2 inhibitors have been thought to be well tolerated by these patients. The aim of this study is to evaluate tolerability to nabumetone and meloxicam in patients with NSAID intolerance. Seventy patients intolerant to NSAIDs were selected. Thirty subjects were patients with asthma with respiratory (rhinitis-asthma) intolerance to NSAIDs (group A); 40 patients (group B) had cutaneous-mucous (urticaria-angioedema) NSAID intolerance. Diagnosis was based on clinical histories in all patients, and it was confirmed by positive single-blind placebo-controlled oral challenge test in 36 patients. After written informed consent, a single-blind placebo-controlled oral challenge test with nabumetone in all patients (2 g except for 11 patients who reached 1 g) and meloxicam (15 mg) in 51 patients was performed. Of the total selected, 94.3% tolerated 1 g nabumetone. In those who reached the 2-g dose, the tolerability was 83.6%. With respect to meloxicam, 96.1% of patients, tolerated 15 mg. No significant difference in nabumetone and meloxicam tolerability was observed between groups A and B. The results of this study confirm a high percentage of tolerability to the maximum therapeutic dosage of nabumetone and meloxicam in patients with NSAID intolerance, both in those with cutaneous/mucous manifestations and in those with respiratory disease. Nabumetone and meloxicam are safe alternatives in NSAID-intolerant patients.