Comparative efficacy of meloxicam and placebo in vasospasm of patients with subarachnoid hemorrhage

ABSTRACT

Cerebral vasospasm considered to be a serious cause of morbidity and mortality following subarachnoid haemorrhage [SAH].Despite several available therapeutic options, current protocols do not prevent major consequences of vasospasm. Inflammation is believed to play an important role in post-haemorrhagic vasospasm. Meloxicam is a non-steroidal anti-inflammatory drug. The aim of this study was to compare the efficacy of meloxicam versus placebo on vasospasm in patients with SAH. In this randomized, double-blind, placebo-controlled trial, SAH patients randomly received 7.5 mg meloxicam or placebo twice daily for 7 days. End points were, middle cerebral artery velocity obtained with transcranial doppler, in-hospital mortality, hospital stay and discharge Glasgow Outcome Scale. Eighty-one patients enrolled in the study. [40 received meloxicam, 41 received placebo]. Baseline characteristics were similar between the groups. There were no differences in length of hospitalization [17.4 +/- 3.1 vs 18.6 +/- 4.2 days; p = 0.145], in-hospital mortality rate [15 vs 22%; p-value=0.569], or GOS [p = 0.972] between the two groups. MCA velocity were slightly less in patients who had received meloxicam, but not to a significant degree [p-value=0.564[. No side effect has been detected for meloxicam. This study did not prove meloxicam efficacy in vasospasm of SAH patients. But it demonstrated that clinical trial of meloxicam in these patients is feasible and probably safe. The effectiveness of meloxicam on cerebral vasospasm has to be studied in larger trials