Research Comparison of Flunixin Meglumine and Firocoxib

A study published in August 2018 in Equine Veterinary Journal was titled, “Multicenter, blinded, randomized clinical trial comparing the use of flunixin meglumine with firocoxib in horses with small intestinal strangulating obstruction.” The study was authored by 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, randomized study, Dr. Amanda Lee Ziegler and colleagues in the USA aimed to determine whether the COX‐2 selective non-steroidal 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‐hours post‐operative plasma samples were assessed for markers of endotoxemia including tumor necrosis factor alpha (TNF-α), prostaglandin E (PGE) and soluble CD14. COX‐2 selectivity was confirmed by the relative lack of inhibition of the COX‐1 prostanoid thromboxane B (TXB). Pain scores were assigned by personnel blinded to NSAID allocation using a standardized system every 12 hours in the first 3 days post‐operatively, then every 24 hours 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 hours 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 endotoxemia at 48 hours post‐operatively as detected by measuring sCD14.

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