Multicentre, blinded, randomised clinical trial comparing the use of flunixin meglumine with firocoxib in horses with small intestinal strangulating obstruction
Ziegler, A.L., Freeman, C.K., Fogle, C.A., Burke, M.J., Davis, J.L., Cook, V.L., Southwood, L.L. and Blikslager, A.T.
In this blinded, randomised study the authors aimed to determine whether the COX‐2 selective nonsteroidal anti-inflammatory drug (NSAID) firocoxib would reduce the signs of endotoxaemia to a greater extent compared to the nonselective COX inhibitor flunixin meglumine in horses with small intestinal strangulating obstructions (SISO).
Fifty-six horses ≥1 year of age that underwent surgical correction of a SISO were randomly allocated to be treated with either flunixin meglumine (1.1 mg/kg bwt i.v. q. 12 h) or firocoxib (0.3 mg/kg bwt i.v. loading dose then 0.1 mg/kg bwt i.v. q. 24 h). Pre- and 12‐, 24‐ and 48‐h post‐operative plasma samples were assessed for markers of endotoxaemia including tumour necrosis factor alpha (TNF-α), prostaglandin E2 (PGE2) and soluble CD14. COX‐2 selectivity was confirmed by the relative lack of inhibition of the COX‐1 prostanoid thromboxane B2 (TXB2). Pain scores were assigned by personnel blinded to NSAID allocation using a standardised system every 12 h in the first 3 days post‐operatively, and then every 24 h for the following 3 days.
There was no significant difference in pain scores, the use of additional analgesia, the incidence of clinical signs attributable to systemic inflammatory response syndrome (SIRS) or multiple organ dysfunction syndrome (MODS), or survival to discharge between groups. There were no significant differences in TNFα and mean sCD14 levels between the two groups at any point; however, at 48 h post‐operatively, 26.9% of horses treated with flunixin meglumine had sCD14 levels exceeding the upper limit of the reference range as compared with 8.33% of horses treated with firocoxib.
Bottom line: Use of firocoxib following surgery for SISO results in similar levels of pain control as compared with horses treated with flunixin meglumine, but firocoxib horses have reduced evidence of endotoxaemia at 48 h post‐operatively as detected by measuring sCD14.