Blue Point LLC, 711 Warrenville Road, Wheaton, IL, 60189, USA.
Baudax Bio Inc, Malvern, PA, USA.
BMC Anesthesiol. 2020 Oct 27;20(1):272. doi: 10.1186/s12871-020-01147-y.
The aim of this network meta-analysis (NMA) was to evaluate the safety and efficacy of intravenous (IV) Meloxicam 30 mg (MIV), an investigational non-steroidal anti-inflammatory drug (NSAID), and certain other IV non-opioid analgesics for moderate-severe acute postoperative pain.
We searched PubMed and CENTRAL for Randomized Controlled Trials (RCT) (years 2000-2019, adult human subjects) of IV non-opioid analgesics (IV NSAIDs or IV Acetaminophen) used to treat acute pain after abdominal, hysterectomy, bunionectomy or orthopedic procedures. A Bayesian NMA was conducted in R to rank treatments based on the standardized mean differences in sum of pain intensity difference from baseline up to 24 h postoperatively (sum of pain intensity difference: SPID 24). The probability and the cumulative probability of rank for each treatment were calculated, and the surface under the cumulative ranking curve (SUCRA) was applied to distinguish treatments on the basis of their outcomes such that higher SUCRA values indicate better outcomes. The study protocol was prospectively registered with by PROSPERO (CRD42019117360).
Out of 2313 screened studies, 27 studies with 36 comparative observations were included, producing a treatment network that included the four non-opioid IV pain medications of interest (MIV, ketorolac, acetaminophen, and ibuprofen). MIV was associated with the largest SPID 24 for all procedure categories and comparators. The SUCRA ranking table indicated that MIV had the highest probability for the most effective treatment for abdominal (89.5%), bunionectomy (100%), and hysterectomy (99.8%). MIV was associated with significantly less MME utilization versus all comparators for abdominal procedures, hysterectomy, and versus acetaminophen in orthopedic procedures. Elsewhere MME utilization outcomes for MIV were largely equivalent or nominally better than other comparators. Odds of ORADEs were significantly higher for all comparators vs MIV for orthopedic (gastrointestinal) and hysterectomy (respiratory).
MIV 30 mg may provide better pain reduction with similar or better safety compared to other approved IV non-opioid analgesics. Caution is warranted in interpreting these results as all comparisons involving MIV were indirect.
本网络荟萃分析（NMA）旨在评估静脉注射（IV）美洛昔康 30mg（MIV）的安全性和疗效，MIV 是一种研究性的非甾体抗炎药（NSAID），以及其他某些 IV 类非阿片类镇痛药治疗中重度急性术后疼痛。
我们在 PubMed 和CENTRAL 中检索了 2000 年至 2019 年的随机对照试验（RCT）（成年人类受试者），这些试验评估了 IV 类非阿片类镇痛药（IV NSAID 或 IV 对乙酰氨基酚）治疗腹部、子宫切除术、拇囊炎切除术或矫形手术后急性疼痛的疗效。我们在 R 中进行了贝叶斯 NMA，根据术后 24 小时内从基线开始的疼痛强度总和差异的标准化均数差（总和疼痛强度差异：SPID24）对治疗方法进行排名。计算了每种治疗方法的概率和累积概率排名，并应用累积排序曲线下面积（SUCRA）根据治疗效果区分治疗方法，即较高的 SUCRA 值表示更好的效果。该研究方案已通过 PROSPERO（CRD42019117360）进行了前瞻性注册。
在筛选出的 2313 项研究中，有 27 项研究包含 36 项对照观察，形成了一个包含四种感兴趣的非阿片类 IV 类止痛药的治疗网络（MIV、酮咯酸、对乙酰氨基酚和布洛芬）。对于所有手术类型和对照药物，MIV 与最大的 SPID24 相关。SUCRA 排名表表明，MIV 在腹部（89.5%）、拇囊炎切除术（100%）和子宫切除术（99.8%）中最有可能成为最有效的治疗方法。与腹部手术、子宫切除术以及骨科手术中的对乙酰氨基酚相比，MIV 与所有对照药物相比，MME 使用率显著降低。在其他方面，MIV 的 MME 使用率与其他对照药物基本相当或略有优势。与 MIV 相比，所有对照药物在骨科（胃肠道）和子宫切除术（呼吸）方面发生 ORADE 的几率都显著更高。
与其他已批准的 IV 类非阿片类镇痛药相比，MIV 30mg 可能具有更好的镇痛效果，且安全性相似或更好。需要谨慎解释这些结果，因为所有涉及 MIV 的比较都是间接的。
