Robenacoxib for Pain Management in Cats with Chronic Musculoskeletal Disease
Alonso Guedes, DVM, MS, PhD, DACVAA, University of Minnesota
In the Literature
King JN, Seewald W, Forster S, Friton G, Adrian DE, Lascelles BDX. Clinical safety of robenacoxib in cats with chronic musculoskeletal disease. J Vet Intern Med. 2021;35(5):2384-2394.
The Research …
Pain management in cats with chronic musculoskeletal disease (eg, osteoarthritis) can be a significant clinical challenge. Prospective clinical trials demonstrating the efficacy of NSAIDs in these cats are typically not sufficiently powered to detect adverse effects of <3% incidence; therefore, there are safety concerns with extended clinical use of these drugs.
This study aimed to detect robenacoxib-associated adverse effects with ≥1% incidence. A pooled analysis of clinical safety variables previously reported in 4 randomized, double-blinded, placebo-controlled, prospective clinical trials in cats with chronic musculoskeletal disease was performed. Data from 449 cats treated once daily with oral robenacoxib (target dose, 1 mg/kg; range, 1-2.4 mg/kg; n = 222) or placebo (n = 227) for 4 to 12 weeks were analyzed. A subset of 126 cats with chronic kidney disease (CKD; primarily International Renal Interest Society [IRIS] stage 2) were also included in the robenacoxib (n = 58) and placebo (n = 68) groups.
Safety was evaluated through changes in clinical pathology variables (ie, hematology, serum chemistry profile, urinalysis) and adverse effects reported by pet owners and clinicians. Variables of primary interest included cats with at least one adverse effect, relative risk for adverse effects, and impact of CKD on adverse effects. Clinical pathology variables were analyzed as secondary outcomes.
There were no significant differences in frequency of adverse effects between cats given placebo or robenacoxib. Serum creatinine concentrations were higher during robenacoxib administration compared with placebo but were not associated with clinical adverse effects. There was no significant effect of CKD or treatment/CKD interaction on adverse effects or serum creatinine.
Clinical tolerability was good in cats with chronic musculoskeletal disease and cats with IRIS stage 2 CKD given oral robenacoxib for 4 to 12 weeks. A possible increase in serum creatinine concentration warrants monitoring. Effect of longer treatment duration (>12 weeks), impact on adverse effects of <1% incidence, potential for GI damage, and effect in cats with more advanced CKD (ie, IRIS stage 3 or 4) are unknown.
… The Takeaways
Key pearls to put into practice:
Extended clinical use of NSAIDs (eg, robenacoxib, meloxicam) in cats is generally safe,1 but patients should be monitored for hepatic, GI, and urinary tract adverse effects.
Because of the role of prostaglandins in regulating renal blood flow during conditions of hypoperfusion (eg, dehydration, hypotension), patients should be euhydrated and normovolemic during NSAID therapy.2
In order to maximize efficacy and minimize dose-related adverse effects in cats with chronic musculoskeletal disease, lower doses of NSAIDs as part of a multimodal approach to pain management should be considered versus higher doses as a single modality.3
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