Abstracts | EQUINE
Multicentre, blinded, randomised clinical trial comparing
the use of flunixin meglumine with firocoxib in horses
with small intestinal strangulating obstruction
A. L. Ziegler, C. K. Freeman, C. A. Fogle, M. J. Burke, J. L. Davis, V. L. Cook, L. L. Southwood, A. T. Blikslager
First published: 29 August 2018
Background
Small intestinal strangulating obstruction (SISO) is
associated with endotoxaemia which leads to an
increased risk of death. Nonsteroidal anti‐inflammatory
drugs (NSAIDs) are used to treat signs of endotoxaemia
by inhibiting cyclo‐oxygenases (COX). COX‐1 is
expressed constitutively and promotes gut barrier
function, whereas COX‐2 is inducible and contributes
to the signs of endotoxaemia. In preclinical SISO trials,
intestinal barrier recovery was more complete with
reductions in endotoxin permeability in horses treated
with COX‐2 selective NSAIDs as compared with horses
treated with flunixin meglumine.
Objectives
We hypothesised that treatment of post‐surgical SISO
horses with firocoxib (COX‐2 selective) would reduce
the signs of endotoxaemia to a greater extent than
flunixin meglumine (nonselective COX inhibitor) while
continuing to provide similar levels of pain control.
Study design
Blinded randomised clinical trial.
Methods
Results
In 56 recruited SISO horses, either flunixin meglumine
(1.1 mg/kg, i.v., q12h) or firocoxib (0.3 mg/kg, i.v.
loading dose; 0.1 mg/kg, i.v., q24h) was given in the
post‐operative period in three university hospitals from
2015 to 2017.
COX‐2 selectivity was confirmed by a relative lack of
inhibition of the COX‐1 prostanoid TXB2 by firocoxib
and significant inhibition by flunixin meglumine (P =
0.014). Both drugs inhibited the COX‐2 prostanoid
PGE2. There were no significant differences in pain
scores between groups (P = 0.2). However, there was a
3.23‐fold increased risk (P = 0.04) of increased plasma
sCD14 in horses treated with flunixin meglumine, a
validated biomarker of equine endotoxaemia.
Main limitations
Horses were all treated with flunixin meglumine prior
to referral. In addition, many horses were treated
with lidocaine, which has been shown to mitigate the
deleterious effects of flunixin meglumine.
Conclusions
In addition to clinical monitoring, preoperative and
12‐, 24‐ and 48‐h post‐operative plasma samples were
assessed for prostaglandin E2 (PGE2), thromboxane B2
(TXB2), TNF⍺ and soluble CD14 (sCD14).
In SISO cases, firocoxib reduced a biomarker of
endotoxaemia as compared with flunixin meglumine
while continuing to provide similar levels of pain
control.
https://doi.org/10.1111/evj.13013
• Volume 21 Issue 1 | March 2019 •
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