Efficacy and safety of piroxicam revisited. A global meta-analysis of randomised clinical trials.

[en] BACKGROUND: The relative efficacy/safety profiles of traditional (non-selective) NSAIDs (t-NSAIDs) have been repeatedly challenged. To better understand the efficacy and safety profile of piroxicam, a widely used NSAID, a meta-analysis of comparative RCTs was carried out according to the QUOROM guidance. METHODS: A systematic comprehensive research (years 1980-2006) of any comparative randomised controlled trial (of over 7-day duration) with piroxicam for the treatment of osteoarticular conditions was conducted. Conservative analyses were stratified by comparator, outcome, indication, duration, and doses. Publication bias and robustness were exhaustively investigated. RESULTS: Seventy-five comparative trials were ultimately included for analyses. Regarding global efficacy, piroxicam was more effective than naproxen [OR=1.37 (1.05; 1.77)] and nabumetone [OR=1.72 (1.26; 2.34)], while equivalent to other NSAIDS [OR=1.06 (0.96; 1.18)]. For pain and articular swelling, piroxicam was statistically equivalent to all other NSAIDs. For mobility, piroxicam appeared to be more effective than indomethacin, while equivalent to all other NSAIDs. Piroxicam was globally safer than other NSAIDs OR=0.84 [0.73; 0.96], notably indomethacin [OR=0.53 (0.43; 0.64], naproxen [OR=0.75 (0.65; 0.85)] and salicylates [OR=0.36 (0.17; 0.75)]. From a global GI safety point of view, piroxicam was better tolerated than indomethacin [OR=0.46 (0.36; 0.58)], naproxen [OR=0.66 (0.53; 0.83)] and salicylates [OR=0.45 (0.27; 0.78)] while less tolerated when compared to meloxicam [OR=1.49 (1.05; 2.13)]. Major GI effects were comparable among piroxicam users as in comparator drugs users [OR=1.33 (0.96; 1.84)], except for meloxicam [OR=2.37 (1.13; 4.97)]. The skin safety of piroxicam was statistically comparable to those of comparators [OR=1.01 (0.68; 1.51)]. CONCLUSION: This meta-analysis of RCTs support a similar to more favourable efficacy/safety profile of piroxicam as compared to other t-NSAIDs.

Disciplines :

Rheumatology

Author, co-author :

Richy, F.

Scarpignato, C.

Lanas, A.

Reginster, Jean-Yves ; Université de Liège - ULiège > Département des sciences de la santé publique > Epidémiologie et santé publique

Language :

English

Title :

Efficacy and safety of piroxicam revisited. A global meta-analysis of randomised clinical trials.

Publication date :

2009

Journal title :

Pharmacological Research

ISSN :

1043-6618

eISSN :

1096-1186

Publisher :

Elsevier, Atlanta, Georgia

Volume :

Pages :

254-263

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 27 August 2009

Statistics

Number of views

203 (8 by ULiège)

Number of downloads

2 (1 by ULiège)

More statistics

Scopus citations^®

Scopus citations^®
without self-citations

OpenCitations

OpenAlex citations

Bibliography

Scarpignato C., Bjarnason I., Bretagne J.-F., De Pouvourville G., García Rodríquez L.A., Goldstein J.L., et al. Working team report: towards a GI safer antiinflammatory therapy. Gastroenterol Int 12 (1999) 186-215
Lanas A., and Hunt R. Prevention of anti-inflammatory drug-induced gastrointestinal damage: benefits and risks of therapeutic strategies. Ann Med 38 (2006) 415-428
McGettigan P., and Henry D. Cardiovascular risk and inhibition of cyclooxygenase: a systematic review of the observational studies of selective and nonselective inhibitors of cyclooxygenase 2. JAMA 296 (2006) 1633-1644
Kearney P.M., Baigent C., Godwin J., Halls H., Emberson J.R., and Patrono C. Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials. BMJ 332 (2006) 1302-1308
Hunt RH, Lanas A, Stichtenoth DO, Scarpignato C. Myths and facts in the use of anti-inflammatory drugs. Ann Med; 2009, May 8: 1-16 [Epub ahead of print].
Sun S.X., Lee K.Y., Bertram C.T., and Goldstein J.L. Withdrawal of COX-2 selective inhibitors rofecoxib and valdecoxib: impact on NSAID and gastroprotective drug prescribing and utilization. Curr Med Res Opin 23 (2007) 1859-1866
Callfee J.E. The Vioxx fallout. American Enterprise Institute for Public Policy Research AEI on-line (2009). http://www.aei.org/publications/pubID.23275/pub_detail.asp
Alacqua M., Trifirò G., Cavagna L., Caporali R., Montecucco C.M., Moretti S., et al. Prescribing pattern of drugs in the treatment of osteoarthritis in Italian general practice: the effect of rofecoxib withdrawal. Arthritis Rheum 59 (2008) 568-574
Public Citizen. Testimony of Sidney M. Wolfe, MD, Before the FDA Arthritis Advisory Committee on the Petition to Ban Piroxicam (Feldene) (HRG Publication#1373) [http://www.citizen.org/publications/release.cfm?ID=5568], 2009.
Anonymous. Piroxicam should remain on US market. React Week 2 (1995) 575
EMEA. European Medicines Agency recommends restricted use of piroxicam. 25 June 2007 [http://www.emea.europa.eu/pdfs/human/press/pr/26514407en.pdf].
Henry D., Lim L.L., Garcia Rodriguez L.A., Perez Gutthann S., Carson J.L., Griffin M., et al. Variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs: results of a collaborative meta-analysis. BMJ 312 (1996) 1563-1566
Hernandez-Diaz S., and Rodriguez L.A. Association between nonsteroidal anti-inflammatory drugs and upper gastrointestinal tract bleeding/perforation: an overview of epidemiologic studies published in the 1990s. Arch Intern Med 160 (2000) 2093-2099
Lewis S.C., Langman M.J., Laporte J.R., Matthews J.N., Rawlins M.D., and Wiholm B.E. Dose response relationships between individual nonaspirin nonsteroidal anti-inflammatory drugs (NANSAIDs) and serious upper gastrointestinal bleeding: a meta-analysis based on individual patient data. Br J Clin Pharmacol 54 (2002) 320-326
Henry D., and McGettigan P. Epidemiology overview of gastrointestinal and renal toxicity of NSAIDs. Int J Clin Pract 135 (2003) 43-49
Lanas A., Serrano P., Bajador E., Fuentes J., and Sáinz R. Risk of upper gastrointestinal bleeding associated with non-aspirin cardiovascular drugs, analgesics and nonsteroidal anti-inflammatory drugs. Eur J Gastroenterol Hepatol 15 (2003) 173-178
Laporte J.R., Ibáñez L., Vidal X., Vendrell L., and Leone R. Upper gastrointestinal bleeding associated with the use of NSAIDs: newer versus older agents. Drug Safe 27 (2004) 411-420
Lanas A., García-Rodríguez L.A., Arroyo M.T., Gomollón F., Feu F., González-Pérez A., et al. Asociación Española de Gastroenterología. Risk of upper gastrointestinal ulcer bleeding associated with selective cyclo-oxygenase-2 inhibitors, traditional non-aspirin non-steroidal anti-inflammatory drugs, aspirin and combinations. Gut 55 (2006) 1731-1738
Garcia Rodriguez L.A. Nonsteroidal antiinflammatory drugs, ulcers and risk: a collaborative meta-analysis. Semin Arthritis Rheum 26 (1997) 16-20
Bollini P., Garcia Rodriguez L.A., Perez Gutthann S., and Walker A. The impact of research quality and study design on epidemiologic estimates of the effect of nonsteroidal anti-inflammatory drugs on upper gastrointestinal tract disease. Arch Intern Med 152 (1992) 1289-1295
Singh G., Scarpignato C., Richy F., Arana A., Lanas A., and Triadafilopoulos G. Bias and observational studies: the case of NSAID-induced GI complications. Ann Rheum Dis 66 Suppl. 2 (2007) 273
Richy F., Bruyere O., Ethgen O., Rabenda V., Bouvenot G., Audran M., et al. Time dependent risk of gastrointestinal complications induced by non-steroidal anti-inflammatory drug use: a consensus statement using a meta-analytic approach. Ann Rheum Dis 63 (2004) 759-766
CEBM. Levels of evidence and grades of recommendations (2005), Oxford Centre for Evidence-based Medicine
Richy F., Scarpignato C., Lanas A., Singh G., and Reginster J.-Y. NSAIDs in the management of musculoskeletal conditions: a comparative meta-analysis of the efficacy and safety profile of piroxicam. Arthritis Rheum 56 Suppl. (2007) S599-S-600
Moher D., Cook D.J., Eastwood S., Olkin I., Rennie D., and Stroup D.F. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet 354 (1999) 1896-1900
Dickersin K., Scherer R., and Lefebvre C. Identifying relevant studies for systematic reviews. BMJ 309 (1994) 1286-1291
Egger M., Davey Smith G., Schneider M., and Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 315 (1997) 629-634
Sterne J.A., Gavaghan D., and Egger M. Publication and related bias in meta-analysis: power of statistical tests and prevalence in the literature. J Clin Epidemiol 53 (2000) 1119-1129
Borenstein M., Hedges L., Higgins J., and Rothstein H. Comprehensive meta-analysis Version 2 (2005), Biostat, Englewood, NJ
Alballa S.R., Al-Nasser A., Al-Arfaj H., Hamooh Z., Al-Sugair S., and Saddique A. A randomized double-blind short-term trial of tenoxicam versus piroxicam in osteoarthritis of the knee. Curr Ther Res Clin Exp 47 (1990) 591-596
Alho A., Jaer O., Slungaard U., and Holme I. piroxicam and naproxen in patients with osteoarthritis of the hip waiting for total hip replacement. Clin Rheumatol 7 (1988) 208-213
Al-Nahdi M. Efficacy and tolerability of long-term tenoxicam versus piroxicam in patients with rheumatoid arthritis or osteoarthritis. Curr Ther Res Clin Exp 52 (1992) 639-645
Aoki T., Kuroki Y., Kageyama T., Irimajiri S., Mizushima Y., and Yamamoto K. Multicentre double-blind comparison of piroxicam and indomethacin in the treatment of lumbar diseases. Eur J Rheumatol Inflam 6 (1983) 247-252
Astorga Paulsen G., Baigun S., Galvao de Figueiredo J., and Gomes de Freitas G. Efficacy and tolerability comparison of etodolac and piroxicam in the treatment of patients with ostesarthritis of the knee. Curr Med Res Opin 12 (1991) 401-412
Atkinson M., Khanna V., Menard H., Russel A.S., and Tannenbaum H. A comparison of tenoxicam and piroxicam in the treatment of rheumatoid arthritis. J Rheumatol 19 (1992) 538-542
Auvinet B., Crielaard J.M., Manteuffel G.E., and Muller P. A double-blind comparison of piroxicam fast-dissolving dosage form and diclofenac enteric-coated tablets in the treatment of patients with acute musculoskeletal disorders. Curr Ther Res Clin Exp 56 (1995) 1142-1153
Bianchi Porro G.B., Petrillo M., Ardizzone S., Caruso I., and Montrone F. Endoscopic assessment of tenoxicam- and piroxicam-induced lesions in osteoarthritic patients. Drug Invest 3 (1991) 53-56
Bird H.A., Hill J., Dixon J.S., Looi D., and Wright V. A double-blind parallel study of tenoxicam and piroxicam in patients with osteoarthrosis. Eur J Rheumatol Inflam 8 (1985) 53-59
Bird H.A., Le Gallez P., Astbury C., Looi D., and Wright V. A parallel group comparison of tenoxicam and piroxicam in patients with ankylosing spondylitis. Pharmatherapeutica 4 (1986) 457-462
Bohl D., Gausmann H., Vorberg G., Sanchez J., Garcia-Barbal R., Sarti J.F., et al. A clinical trial comparing a new NSAID (droxicam) and piroxicam in spinal osteoarthritis. Int J Clin Pharmacol Ther 28 (1990) 416-419
Bonardelli P., Oliani C., Monici Preti P.A., Pellicanò P., and Quattrocchi G. Efficacy and gastrointestinal tolerability of beta-cyclodextrin-piroxicam and tenoxicam in the treatment of chronic osteoarthritis. Clin Ther 12 (1990) 547-555
Bouchier-Hayes T.A. Naproxen sodium and piroxicam in acute musculo-skeletal disorders. Br J Sports Med 18 (1984) 80-83
Briancon D., Peterschmitt J., and Laviec G. Double-blind parallel-group evaluation of the safety and efficacy of etodolac capsules compared with piroxicam capsules in patients with rheumatoid arthritis. Acta Ther 17 (1991) 35-47
Caldwell J.R. Comparison of the efficacy, safety, and pharmacokinetic profiles of extended-release ketoprofen and piroxicam in patients with rheumatoid arthritis. Clin Ther 16 (1994) 222-235
Chang D.M., Young T.H., Hsu C.T., Kuo S.Y., and Hsieh T.C. Endoscopic comparison of the gastroduodenal safety and the effects on arachidonic acid products between meloxicam and piroxicam in the treatment of osteoarthritis. Clin Rheumatol 20 (2001) 104-113
Consoli G., Covelli M., Di Matteo L., Marcolongo R., Tirri G., La Montagna G., et al. Fast-dissolving sublingual tablets of piroxicam versus naproxen in the treatment of recurrent acute osteoarthrosis. Multicenter clinical trial. Min Med 85 (1994) 89-96
Cornhill J., and Rowley-Jones D. Is sustained-release ibuprofen as effective as piroxicam? A comparison in patients with osteoarthritis. Eur J Rheumatol Inflam 7 (1984) 114-121
Crielaard J.-M., Chapelle C.H., Joos E., Spans E., and Lysens R. Treatment of acute musculoskeletal disorders with piroxicam fast- dissolving dosage form tablets versus naproxen film-coated tablets: a pilot study. Curr Ther Res Clin Exp 60 (1999) 661-671
De Bock G.H., Hermans J., and Mulder J.D. Randomized double-blind study of nabumetone and piroxicam in the treatment of osteoarthritis in Dutch general practice: efficacy and tolerability. Pharm World Sci 15 (1993) 132-138
Dequeker J., Hawkey C., Kahan A., Steinbruck K., Alegre C., Baumelou E., et al. Improvement in gastrointestinal tolerability of the selective cyclooxygenase (COX)-2 inhibitor, meloxicam, compared with piroxicam: results of the Safety and Efficacy Large-scale Evaluation of COX-inhibiting Therapies (SELECT) trial in osteoarthritis. Br J Rheumatol 37 (1998) 946-951
Dick W.C., Franchimont P., and Veys E. Double-blind comparison of etodolac and piroxicam in the treatment of rheumatoid arthritis. Clin Ther 15 (1993) 148-159
Dreiser R.L., and Riebenfeld D. Nimesulide in the treatment of osteoarthritis. Double-blind studies in comparison with piroxicam, ketoprofen and placebo. Drugs 46 Suppl. 1 (1993) 191-195
Edwards V., Wilson A.A., Harwood H.F., Manning S.I., Brabbin W., Walker J.W., et al. A multicentre comparison of piroxicam and indomethacin in acute soft tissue sports injuries. J Int Med Res 12 (1984) 46-50
Ersmark H., Tjornstrand B., Gudmundsson G., Duppe H., Fagerlund M., Jacobsson B., et al. Piroxicam and indometacin suppositories for painful coxarthrosis. Clin Rheumatol 11 (1992) 37-40
Galasso G., Tamburro P., and Vecchiet L. Analgesic activity of beta-cyclodextrin-piroxicam and tenoxicam in acute soft tissue injuries. Adv Ther 7 (1990) 43-50
Garcia-Morteo O., Maldonado-Cocco J.A., Cuttica R., and Garay S.M. Piroxicam in juvenile rheumatoid arthritis. Eur J Rheumatol Inflam 8 (1987) 49-53
Gerecz-Simon E., Soper W.Y., Kean W.F., Rooney P.J., Tugwell P., and Buchanan W.W. A controlled comparison of piroxicam and diclofenac in patients with osteoarthritis. Clin Rheumatol 9 (1990) 229-234
Ghozlan P.R., Bernhardt M., Vélicitat P., and Bluhmki E. Tolerability of multiple administration of intramuscular meloxicam: a comparison with intramuscular piroxicam in patients with rheumatoid arthritis or osteoarthritis. Br J Rheumatol 35 Suppl. 1 (1996) 51-55
Gotter G. Comparative evaluation of tenoxicam and piroxicam in the treatment of humeroscapular periarthritis. Eur J Rheumatol Inflam 9 (1987) 95-97
Heere L.P. Piroxicam in acute musculoskeletal disorders and sports injuries. Am J Med 84 Suppl 5A (1988) 50-55
Hosie J., Distel M., and Bluhmki E. Efficacy and tolerability of meloxicam versus piroxicam in patients with osteoarthritis of the hip or knee. A six-month double-blind study. Clin Drug Invest 13 (1997) 175-184
Husby G., Holme I., Rugstad H.E., Herland O.B., and Giercksky K.E. A double-blind multicentre trial of piroxicam and naproxen in osteoarthritis. Clin Rheumatol 5 (1986) 84-91
Jakobsen T.J., Petersen L., Christiansen S., Haarbo J., Munch M., Larsen P.B., et al. Double-blind comparative study of tenoxicam, piroxicam, and placebo in acute soft-tissue injuries. Curr Ther Res Clin Exp 44 (1988) 516-527
Jennings M.B. A comparison study of piroxicam and ibuprofen in osteoarthritis of the foot. Foot 6 (1996) 58-62
Jennings M.B. Comparison of piroxicam and naproxen in osteoarthritis of the foot. J Am Pod Med Assoc 84 (1994) 348-354
Jubb R.W., Platt P., and Price T.R. Double-blind comparison of etodolac sustained-release tablets and piroxicam capsules in patients with rheumatoid arthritis: an interim report. Curr Ther Res Clin Exp 52 (1992) 769-779
Kraag G.R., Lussier A., Treteault L.L., Segal N.B., Percy J.S., Thompson J.M., et al. Piroxicam vs. indomethacin: a double blind multicenter comparative study in osteoarthritis. A Canadian multicenter study. J Rheumatol 12 (1985) 328-336
Kroll M.P., Wiseman R.L., and Guttadauria M. A clinical evaluation of piroxicam gel: an open comparative trial with diclofenac gel in the treatment of acute musculoskeletal disorders. Clin Ther 11 (1989) 382-391
La Montagna G., Parenti M., Oliani C., Filippi F., and Tirri G. Beta-cyclodextrin-piroxicam in the treatment of the active phase of osteoarthritic pathology. Eur Rev Med Pharmacol Sci 12 (1990) 265-272
Lang E., and Steger W. A comparative study of efficacy and tolerability of ketoprofen and piroxicam. Br J Clin Pract 35 (1981) 267
Lee H.K., Chung M.S., Lee S.H., Lee K.H., and Lee F.Y.I. Double-blind evaluation of the safety and efficacy of tenoxicam (Tilcotil™) compared with piroxicam in patients with degenerative arthritis. Drug Invest 2 Suppl. 3 (1990) 50-51
Lightfoot R. Comparison of the efficacy and safety of etodolac and piroxicam in patients with rheumatoid arthritis. Etodolac Study 326 Rheumatoid Arthritis Investigators Group. J Rheumatol 47 Suppl. (1997) 10-16
Lister B.J., Poland M., and DeLapp R.E. Efficacy of nabumetone versus diclofenac, naproxen, ibuprofen, and piroxicam in osteoarthritis and rheumatoid arthritis. Am J Med 95 Suppl. 2A (1993) 2S-9S
Linden B., Distel M., and Bluhmki E. A double-blind study to compare the efficacy and safety of meloxicam 15 mg with piroxicam 20 mg in patients with osteoarthritis of the hip. Br J Rheumatol 35 Suppl. 1 (1996) 35-38
Lochead J.A., Baragar F.D., Tetreault L.L., Davis M.A., Thompson J.M., DeCoteau E., et al. A double blind comparison of piroxicam and enteric coated ASA in rheumatoid arthritis. A Cooperative Multicenter Canadian trial. J Rheumatol 12 (1985) 68-77
Lund B., Andersen R.B., Fossgreen J., Holm P., Jensen E.M., Kirchheiner B., et al. A long-term randomised trial on tenoxicam and piroxicam in osteoarthritis of the hip or knee: a 24-month interim report focusing on the 12-24 month interval. Eur J Rheumatol Inflam 9 (1987) 58-67
Mbuyi-Muamba J.M., and Dequeker J. Piroxicam versus naproxen in rheumatoid arthritis. Curr Med Res Opin 8 (1983) 612-617
Meaders M.A., and Wiseman R.L. A randomized multicenter comparison of piroxicam and diclofenac in the treatment of acute musculoskeletal injuries. Curr Ther Res Clin Exp 47 (1990) 971-981
Melo Gomes J.A., Roth S.H., Zeeh J., Bruyn G.A., Woods E.M., and Geis G.S. Double-blind comparison of efficacy and gastroduodenal safety of diclofenac/misoprostol, piroxicam, and naproxen in the treatment of osteoarthritis. Ann Rheum Dis 52 (1993) 881-885
Misra N.P. A comparative study of flurbiprofen and piroxicam in osteoarthritis. J Postgrad Med 38 (1992) 164-166
Montrone F., Caruso I., and Cazzola M. Salsalate in the treatment of rheumatoid arthritis: a double-blind clinical and gastroscopic trial versus piroxicam. I. Clinical trial. J Int Med Res 17 (1989) 316-319
Moran M. An observer-blind comparison of diclofenac potassium, piroxicam and placebo in the treatment of ankle sprains. Curr Med Res Opin 12 (1990) 268-274
Morgan G.J., Poland M., and DeLapp R.E. Efficacy and safety of nabumetone versus diclofenac, naproxen, ibuprofen, and piroxicam in the elderly. Am J Med 95 (1993) 19S-27S
Moser U., Waldburger H., Schwarz H.A., and Gobelet C.A. A double-blind randomised multicentre study with tenoxicam, piroxicam and diclofenac sodium retard in the treatment of ambulant patients with osteoarthritis and extra-articular rheumatism. Scand J Rheumatol 80 Suppl (1989) 71-80
Muller-Fassbender H.H., and Nagel E. Comparative study of piroxicam and indomethacin retard in osteoarthritis. Eur J Rheumatol Inflam 6 (1983) 106-112
Perez Busquier M., Calero E., Rodriguez M., Castellon Arce P., Bermudez A., Linares L.F., et al. Comparison of aceclofenac with piroxicam in the treatment of osteoarthritis. Clin Rheumatol 16 (1997) 154-159
Rice D.M. Comparison of diflunisal and piroxicam in the management of patients with rheumatoid arthritis. Clin Ther 10 (1987) 92-97
Rogind H., Bliddal H., Klokker D., and Jensen F. Comparison of etodolac and piroxicam in patients with osteoarthritis of the hip or knee: a prospective, randomised, double-blind, controlled multicentre study. Clin Drug Invest 13 (1997) 66-75
Rosenthal M. The efficacy of flurbiprofen versus piroxicam in the treatment of acute soft tissue rheumatism. Curr Med Res Opin 9 (1984) 304-309
Schattenkirchner M. Double-blind comparison of etodolac and piroxicam in patients with rheumatoid arthritis. Curr Med Res Opin 12 (1991) 497-506
Schuetz E., Sanchez J., Garcia-Barbal J., Sarti J.F., Reuter C., and Harrison F.J. Therapeutic activity, clinical and gastric tolerance of 20 mg daily dose of droxicam in comparison with piroxicam in patients with degenerative joint disease. Eur J Rheumatol Inflam 11 (1991) 21-28
Sharma S., Rastogi S., Gupta V., Rohtagi D., and Gulati P. Comparative efficacy and safety of nimesulide versus piroxicam in osteoarthritis with special reference to chondroprotection. Am J Ther 6 (1999) 191-197
Simpson J., Golding D.N., Freeman A.M., Cooke D., Hooper P.A., Jamieson V., et al. A large multicentre, parallel group, double-blind study comparing tenoxicam and piroxicam in the treatment of osteoarthritis and rheumatoid arthritis. Br J Clin Pract 43 (1989) 328-333
Smith M.D., Thomas D., McCredie M., and Brooks P.M. Piroxicam versus naproxen in the treatment of painful shoulder. Pharmatherapeutica 4 (1986) 585-589
Sydnes O.A. Comparison of piroxicam with naproxen in rheumatoid arthritis: a double-blind, cross-over, multicentre study. Eur J Rheumatol Inflam 4 (1981) 318-322
Tannenbaum H., DeCoteau W.E., Esdaile J.M., Ryan J.P., Fenton S., Markland J., et al. A double blind multicenter trial comparing piroxicam and indomethacin in ankylosing spondylitis with long-term follow-up. Curr Ther Res Clin Exp 36 (1984) 426-435
Torri G., Vignati C., Agrifoglio E., Benvenuti M., Ceciliani L., Raschella B.F., et al. Aceclofenac versus piroxicam in the management of osteoarthritis of the knee: a double-blind controlled study. Curr Ther Res Clin Exp 55 (1994) 576-583
Valdes E.F., Barclay C.A., and Traballi C.A. Tenoxicam a novel long-acting anti-inflammatory and analgesic drug of the oxicam class: double-blind comparative study with piroxicam in patients with gona or coxarthrosis. Curr Ther Res Clin Exp 37 (1985) 937-944
Videman T., and Osterman K. Double-blind parallel study of piroxicam versus indomethacin in the treatment of low back pain. Ann Clin Res 16 (1984) 156-160
Waterworth R.F., and Petrie J.P. Double-blind comparative study of etodolac and piroxicam in patients with osteoarthritis of the knee. Adv Ther 9 (1992) 240-249
Wiseman R.L., Sodergren J., Guttadauria M., and Ryan A.J. Treatment of acute musculoskeletal disorders with piroxicam: results of a double-blind multicenter comparison with naproxen. Curr Ther Res Clin Exp 42 (1987) 974-987
Wiseman R.L., Sodergren J., Guttadauria M., and Ryan A.J. Treatment of acute musculoskeletal disorders with piroxicam: results of a double-blind multicenter comparison with indomethacin. Curr Ther Res Clin Exp 42 (1987) 517-529
Yamamoto M., Sugano T., Kashiwazaki S., Kageyama T., Mizushima Y., and Kameyama M. Double-blind comparison of piroxicam and indomethacin in the treatment of cervicobrachial syndrome and periarthritis scapulohumeralis (stiff shoulder). Eur J Rheumatol Inflam 6 (1983) 266-273
Zizic T.M., Stevens M.B., and Sutton J.D. Piroxicam in osteoarthritis: a controlled long-term study. Postgrad Med Spec Issue (1983) 32-40
Jadad A.R., Moore R.A., Carroll D., Jenkinson C., Reynolds D.J., Gavaghan D.J., et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials 17 (1996) 1-12
Engelhardt G. Pharmacology of meloxicam, a new non-steroidal anti-inflammatory drug with an improved safety profile through preferential inhibition of COX-2. Br J Rheumatol 35 Suppl 1 (1996) 4-12
Griffin M.R., Piper J.M., Daugherty J.R., Snowden M., and Ray W.A. Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons. Ann Intern Med 114 (1991) 257-263
Lanza L.L., Walker A.M., Bortnichak E.A., and Dreyer N.A. Peptic ulcer and gastrointestinal hemorrhage associated with nonsteroidal anti-inflammatory drug use in patients younger than 65 years. A large health maintenance organization cohort study. Arch Intern Med 155 (1995) 1371-1377
Pérez Gutthann S., García Rodríguez L.A., Raiford D.S., Duque Oliart A., and Ris Romeu J. Nonsteroidal anti-inflammatory drugs and the risk of hospitalization for acute renal failure. Arch Intern Med 156 (1997) 2433-2439
Shariff S.Z., Cuerden M.S., Jain A.K., and Garg A.X. The secret of immortal time bias in epidemiologic studies. J Am Soc Nephrol 19 (2008) 841-843
Choi B.C., and Pak A.W. Understanding and minimizing epidemiologic bias in public health research. Can J Public Health 96 (2005) 284-286
Jick S. The risk of gastrointestinal bleed, myocardial infarction and newly diagnosed hypertension in users of meloxicam, diclofenac, naproxen and piroxicam. Pharmacotherapy 20 (2000) 741-744
Singh G., Vadhavkar S., Mithal A., and Triadafilopoulos G. Condemned without a trial: a population-based, comparative, gastrointestinal safety study of piroxicam, ibuprofen, naproxen and diclofenac. Gut 56 Suppl. 3 (2007) 230
Naldi L., Conforti A., Venegoni M., Troncon M.G., Caputi A., Ghiotto E., et al. Cutaneous reactions to drugs. An analysis of spontaneous reports in four Italian regions. Br J Clin Pharmacol 48 (1999) 839-846
Helin-Salmivaara A., Virtanen A., Vesalainen R., Gronroos J.M., Klaukka T., Idanpaan-Heikkila J.E., et al. NSAID use and the risk of hospitalization for first myocardial infarction in the general population: a nationwide case-control study from Finland. Eur Heart J 27 (2006) 1657-1663
García Rodríguez L.A., Perez Gutthann S., Walker A.M., and Lueck L. The role of non-steroidal anti-inflammatory drugs in acute liver injury. BMJ 305 (1992) 688-865
García Rodríguez L.A., Williams R., Derby L.E., Dean A.D., and Jick H. Acute liver injury associated with nonsteroidal anti-inflammatory drugs and the role of risk factors. Arch Intern Med 154 (1994) 311-316
Lanza L.L., Walker Am, Bortnichak B.A., Gause D.O., and Dreyer N.A. Incidence of symptomatic liver function abnormalities in a cohort of NSAID users. Pharmacoepidemiol Drug Safe 4 (1995) 231-237
Traversa G., Bianchi C., Da Cas R., Abraha I., Menniti-Ippolito F., and Venegoni M. Cohort study of hepatotoxicity associated with nimesulide and other non-steroidal anti-inflammatory drugs. BMJ 327 (2003) 18-22
Singh G., Vadhavkar S., Mithal A., and Triadafilopoulos G. Persistence with treatment suggests that the use of piroxicam in clinical practice is more valuable than previously perceived. Ann Rheum Dis 67 Suppl. 2 (2008) 394
Arellano F.M., Yood M.U., Wentworth C.E., Oliveria S.A., Rivero E., Verma A., et al. Use of cyclo-oxygenase 2 inhibitors (COX-2) and prescription non-steroidal anti-inflammatory drugs (NSAIDs) in UK and USA populations. Implications for COX-2 cardiovascular profile. Pharmacoepidemiol Drug Saf 15 (2006) 861-872