Imagine this clinical scenario: a client has brought in their pet cat after spotting blood in its urine. After analysing urine samples and X-raying the patient’s bladder, you diagnose feline interstitial cystitis (FIC), also known as feline lower urinary tract disease (FLUTD).
You understand that a course of anti-inflammatory medication may help with effective analgesia for the patient. You identify meloxicam and prednisolone as possible anti-inflammatory medications, but you aren’t sure which would be the best choice. You decide to consult the literature to explore whether meloxicam or prednisolone will be more beneficial for the cat.
The evidence
Two papers were critically reviewed, both of which were double-blinded randomised controlled trials (Dorsch et al., 2016; Osborne et al., 1996). The former examined the use of meloxicam to treat FIC, while the latter examined the use of prednisolone to treat FLUTD. A third paper – a single-blinded randomised controlled trial – unrelated to the PICO question, was also reviewed as the question is touched upon in the discussion section (Nivy et al., 2019).
Sample sizes ranged from 11 to 51 patients. Obstructed (Dorsch et al., 2016; Nivy et al., 2019) and unobstructed (Osborne et al., 1996) cats were studied.
The outcomes studied were the time to reduction of clinical signs and the time to development of recurrent urethral obstruction.
Limitations of the evidence
Overall, the quality of evidence was weak because no studies were identified that directly compared the use of meloxicam and prednisolone to treat FIC. Other weaknesses include experimental design flaws, spare recording data, small sample sizes and the fact that the populations analysed may not be comparable. In one case, a patient was resubmitted for the same study, which could have skewed the data.
Overall, the quality of evidence was weak because no studies were identified that directly compared the use of meloxicam and prednisolone to treat FIC
Two further papers were identified which were unavailable for analysis, and the findings of these may have had an impact on the relevance of the findings below.
Summary of findings
Meloxicam versus placebo
Dorsch et al. (2016) found that there was no statistically significant difference in the time taken to see a reduction in clinical signs between the use of meloxicam and the use of a placebo in cats with obstructive FIC.
There was no statistically significant difference in the time taken to see a reduction in clinical signs between the use of meloxicam and the use of a placebo
The patients were split into two groups. After 24 hours, 18 were treated with meloxicam and 19 were given a placebo. Procedures performed relating to fluid therapy, urinary catheterisation, buprenorphine treatment and urinalyses were the same for both groups. Thereafter, owners were given written instructions on how to complete a five-day treatment course at home and were asked to record their cat’s progress on a standardised questionnaire.
The outcome assessed was the time until the development of a recurrent urethral obstruction. Clinician-assessed measures were: general demeanour, pain on abdominal palpation, food intake and urinalysis results. Owner-assessed measures were: general demeanour, food intake and urine-voiding behaviour.
Prednisolone versus placebo
Osborne et al. (1996) found no significant difference in the time until a reduction of clinical signs between the use of prednisolone and the use of a placebo in cats with idiopathic FLUTD.
No significant difference [was found] in the time until a reduction of clinical signs between the use of prednisolone and the use of a placebo
The cats were split into two groups: six were treated with prednisolone and six were given a placebo. However, one cat was entered into the study twice due to a second episode of idiopathic FLUTD within six months of its initial trial. This cat was given prednisolone on its first entry and a placebo on its second. All were hospitalised for 10 days, with urine samples collected daily. Subsequently, owners were asked to record their cat’s progress on a standardised questionnaire.
The outcome assessed was the time until a reduction of clinical signs was observed. Clinician-assessed measures were: urine dipstick results, urine sediment exam, clinical examination and radiography. The variables that owners were asked to monitor at home are not recorded.
Other studies
A study by Nivy et al. (2019) on the use of phenoxybenzamine and alprazolam both with and without meloxicam in the treatment of FIC in male cats found that the addition of low-dose meloxicam (0.025mg/kg q24h PO) to phenoxybenzamine and alprazolam treatment did not make a significant difference in the return to urethral obstruction and/or FIC compared with cats only treated with phenoxybenzamine and alprazolam. However, it is possible that the dose rate used in this study was not high enough to be effective.
Conclusion
There is insufficient evidence to prove whether meloxicam or prednisolone is the superior course of treatment for cats with FIC. There is weak evidence to suggest that there is no difference between the use of meloxicam and a placebo and prednisolone and a placebo in the reduction of clinical signs of FIC.
There is insufficient evidence to prove whether meloxicam or prednisolone is the superior course of treatment for cats with feline interstitial cystitis
Further prospective research is necessary to substantiate these findings. It would be beneficial to conduct studies that directly compare the use of meloxicam and prednisolone and that include obstructed and unobstructed animals.
| The full Knowledge Summary can be read in RCVS Knowledge’s open access journal Veterinary Evidence. |
Disclaimer
The application of evidence into practice should take into account multiple factors, not limited to individual clinical expertise, patient’s circumstances, owner’s values, the individual case in front of you, the availability of therapies and resources, and the country, location or clinic where you work.
Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
