Re: Gastrointestinal tolerability of meloxicam compared to diclofenac in osteoarthritis patients (C. Hawkey et al., Br J Rheumatol 1998;37:937–45)

A. K. P. Jones

Human Physiology and Pain Research Laboratory, Rheumatic Diseases Centre, Clinical Sciences Building, Hope Hospital, Eccles Old Road, Salford M6 8HD, UK

SIR, The setting up of such a large double-blind study is to be applauded. However, it is a great shame that such an ambitious study should have one fundamental flaw: equivalent analgesic doses in the meloxicam and diclofenac arms of the study were not used. It is, therefore, impossible to assess the clinical relevance of any COX-2 selectivity of meloxicam from these data. These results, therefore, really provide no support for the hypothesis that COX-2 in selective drugs provides clinical advantage. Unfortunately, it is therefore another case of interesting science driving clinical fantasy. There is obviously a place for that as long as it does not further increase the burden on the NHS drugs bill.

Accepted 29 January 1999