This information is intended for US healthcare professionals.

Postoperative Administration in BunionectomyPostoperative Administration of ANJESO Significantly Reduced Pain Following Bunionectomy1,2,*

Primary Endpoint foot
Secondary Endpoints

Greater proportion of patients reported2:

  • ≥30% pain reduction at 24 hours (P<0.05) (37% vs 22% for ANJESO and placebo, respectively)
  • Pain reduction at all postdose intervals with ANJESO (P<0.05) (hour 6, hour 12, hour 24, and hours 24-48)*

A greater percentage of ANJESO patients reported good to excellent pain control
at 24 hours vs placebo patients (P<0.05)2


Rescue medication was provided Q2h PRN.
PRN, when necessary; Q2h, every 2 hours.

*Pain reduction observed with once-daily dosing. The approved dosage of ANJESO is one 30 mg dose given every 24 hours.

Preoperative Administration in Total Knee ArthroplastyPreoperative Administration of ANJESO Reduced Pain Through Critical Recovery Milestones3,4
This phase 3b study was not submitted to or evaluated by the FDA as part of ANJESO's approval.


SPI scores from first dose to time points

ANJESO patients reported significantly better scores on the OBAS vs placebo patients on postoperative day 1. OBAS scores on postoperative days 2 and 3, and prior to discharge, were lower for ANJESO vs placebo patients, but not statistically significant3,§

NS, not significant; OBAS, overall benefit of analgesia score; TKA, total knee arthroplasty; SPI, summed pain intensity.

SPI from time of first study drug dose to specified time point.

§These assessments are validated patient-reported outcomes tools, which were included as secondary endpoints in the studies and were part of the apriori statistical analysis plans.3

phase 3b study design

Beginning preoperatively, patients received study drug Q24h until discharge, or until IV analgesia was no longer clinically appropriate. Patients received pre-, peri-, and postoperative clinical care per standardized protocol defining medication use and other surgical and recovery activities; no additional NSAIDs were allowed.4

Q24h, every 24 hours.

Postoperative Administration in AbdominoplastyPostoperative Administration of ANJESO Significantly Reduced Pain Following Abdominoplasty1,5

Primary Endpoint foot
Secondary Endpoints

Greater proportion of patients reported5:

  • ≥30% pain reduction at 24 hours (P<0.05) (72% for ANJESO vs 57% for placebo)
  • Pain reduction at all postdose intervals (hour 12, hour 24, and hours 24-48 [P<0.05] except for hours 0-6 [NS])

A greater percentage of ANJESO patients reported good to excellent pain control at 48 hours vs placebo patients (P<0.05)5

  • ANJESO was administered once every 24 hours5
  • Patients received a minimum of 2 doses, and a majority received an optional third dose prior to discharge at 48 hours5
  • Most patients received at least 1 rescue opioid dose within the first 24 hours5

Based on actual SPID data from the clinical trials.4

Approved dose is up to 24 hours.

Abdominoplasty Image

#Rescue medication (oxycodone 5 mg) was provided every 2 hours as needed for pain.5

**Study drug administered at hours 0 and 24, with an optional third dose prior to discharge.5

Preoperative Administration in Colorectal SurgeryPreoperative Administration of ANJESO Significantly Reduced Time to Bowel Function Recovery6This phase 3b study was not submitted to or evaluated by the FDA as part of ANJESO's approval.


ANJESO patients reported a significant pain improvement on the Brief Pain Inventory vs placebo on postoperative day 16,††

  • A faster return of normal bowel function is particularly important for patients undergoing colorectal surgery, and is often the reason why patients require a longer stay in the hospital6

††These assessments are validated patient-reported outcomes tools, which were included as secondary endpoints in the studies and were part of the apriori statistical analysis plans.6

Colorectal Surgery

Patients received study drug Q24h until discharge, or until IV analgesia was no longer clinically appropriate. Patients received pre-, peri-, and postoperative clinical care per standardized protocol defining medication use and other surgical and recovery activities.

PRN, as needed; Q24h, every 24 hours.

INDICATION

ANJESO is indicated for use in adults for the management of moderate-to-severe pain, alone or in combination with non-NSAID analgesics.

Limitation of Use: Because of delayed onset of analgesia, ANJESO alone is not recommended for use when rapid onset of analgesia is required.

IMPORTANT SAFETY INFORMATION

WARNING: RISK OF SERIOUS CARDIOVASCULAR AND GASTROINTESTINAL EVENTS

Cardiovascular Risk

  • Non-steroidal anti-inflammatory drugs (NSAIDs) cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use.
  • ANJESO is contraindicated in the setting of coronary artery bypass graft (CABG) surgery.

Gastrointestinal Risk

  • NSAIDs cause an increased risk of serious gastrointestinal (GI) adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients and patients with a prior history of peptic ulcer disease and/or GI bleeding are at greater risk for serious GI events.

CONTRAINDICATIONS

ANJESO is contraindicated in patients with:

  • Known hypersensitivity (eg, anaphylactic reactions and serious skin reactions) to meloxicam or any components of the drug product.
  • History of asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs.
  • In the setting of coronary artery bypass graft (CABG) surgery.
  • Moderate to severe renal insufficiency patients who are at risk for renal failure due to volume depletion.

WARNINGS AND PRECAUTIONS

Hepatotoxicity: Elevations of ALT or AST have been reported in patients with NSAIDs. In addition, rare, sometimes fatal, cases of severe hepatic injury including fulminant hepatitis, liver necrosis, and hepatic failure have been reported. Inform patients of warning signs and symptoms of hepatotoxicity. Discontinue ANJESO immediately if abnormal liver tests persist or worsen or if clinical signs and symptoms of liver disease develop.

Hypertension: NSAIDs including ANJESO can lead to new onset of hypertension or worsening of preexisting hypertension, which may contribute to the increased incidence of cardiovascular (CV) events. Patients taking some antihypertensive medications may have impaired response to these therapies when taking NSAIDs. Monitor blood pressure.

Heart Failure and Edema: NSAID use increased the risk of myocardial infarction (MI), hospitalization for heart failure, and death. Avoid use of ANJESO in patients with severe heart failure unless benefits are expected to outweigh risk of worsening heart failure. If ANJESO is used in patients with severe heart failure, monitor patients for signs of worsening heart failure.

Post MI Patients: Avoid the use of ANJESO in patients with recent MI unless the benefits are expected to outweigh the risk of recurrent CV thrombotic events. If ANJESO is used in these patients, monitor for signs of cardiac ischemia.

Renal Toxicity: Long-term administration of NSAIDs has resulted in renal papillary necrosis, renal insufficiency, acute renal failure, and other renal injury. ANJESO is not recommended in patients with moderate to severe renal insufficiency and is contraindicated in patients with moderate to severe renal insufficiency who are at risk for renal failure due to volume depletion. Correct volume status in dehydrated or hypovolemic patients prior to initiating ANJESO. Monitor renal function in patients with renal or hepatic impairment, heart failure, dehydration, or hypovolemia. Avoid use of ANJESO in patients with advanced renal disease unless benefits are expected to outweigh risk of worsening renal function. If ANJESO is used in patients with advanced renal disease, monitor patients for signs of worsening renal function.

Anaphylactic Reactions: Meloxicam has been associated with anaphylactic reactions in patients with and without known hypersensitivity to meloxicam and in patients with aspirin-sensitive asthma. Seek emergency help if an anaphylactic reaction occurs.

Exacerbation of Asthma Related to Aspirin Sensitivity: ANJESO is contraindicated in patients with aspirin-sensitive asthma. Monitor patients with preexisting asthma (without aspirin sensitivity).

Serious Skin Reactions: NSAIDs, including ANJESO, can cause serious skin reactions, including exfoliative dermatitis, Stevens-Johnson Syndrome (SJS), and toxic epidermal necrolysis (TEN), which can be fatal and can occur without warning. Discontinue ANJESO at first appearance of skin rash or other signs of hypersensitivity.

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Inform patients to stop taking ANJESO immediately if they develop any type of rash or fever and to contact their healthcare provider as soon as possible.

Hematologic Toxicity: Anemia has occurred in NSAID-treated patients. Monitor hemoglobin or hematocrit in patients with any signs or symptoms of anemia. NSAIDs, including ANJESO, may increase the risk of bleeding events. Monitor patients for signs of bleeding.

Fetal Toxicity: Limit use of NSAIDs, including ANJESO, between about 20 to 30 weeks in pregnancy due to the risk of oligohydramnios/fetal renal dysfunction. Avoid use of NSAIDs in women at about 30 weeks gestation and later in pregnancy due to the risks of oligohydramnios/fetal renal dysfunction and premature closure of the fetal ductus arteriosus.

DRUG INTERACTIONS

Drugs That Interfere With Hemostasis (eg, warfarin, aspirin, SSRIs/SNRIs): Monitor patients for bleeding who are concomitantly taking ANJESO with drugs that interfere with hemostasis. Concomitant use of ANJESO and analgesic doses of aspirin is not generally recommended.

ACE Inhibitors, Angiotensin Receptor Blockers (ARB), or Beta-Blockers: Concomitant use with ANJESO may diminish the antihypertensive effect of these drugs. Monitor blood pressure.

ACE Inhibitors and ARBs: Concomitant use with ANJESO in elderly, volume depleted, or those with renal impairment may result in deterioration of renal function. In such high risk patients, monitor for signs of worsening renal function.

Diuretics: NSAIDs can reduce natriuretic effect of furosemide and thiazide diuretics. Monitor patients to ensure diuretic efficacy including antihypertensive effects.

ADVERSE REACTIONS

The most common adverse reactions in controlled clinical trials occurring in ≥ 2% of patients treated with ANJESO and at a greater frequency than placebo include: constipation, gamma-glutamyl transferase increased, and anemia.

USE IN SPECIFIC POPULATIONS

Pregnancy: Use of NSAIDs, including ANJESO, can cause premature closure of the fetal ductus arteriosus and fetal renal dysfunction leading to oligohydramnios and, in some cases, neonatal renal impairment. Because of these risks, limit dose and duration of ANJESO use between about 20 and 30 weeks of gestation and avoid ANJESO use at about 30 weeks of gestation and later in pregnancy.

Infertility: NSAIDs are associated with reversible infertility. Consider withdrawal of ANJESO in women who have trouble conceiving.

Please see full Prescribing Information, including Boxed Warning at www.anjeso.com.

References: 1. ANJESO [package insert]. Malvern, PA: Baudax Bio, Inc.; 2021. 2. Pollak RA, Gottlieb IJ, Hakakian F, et al. Efficacy and safety of intravenous meloxicam in patients with moderate-to-severe pain following bunionectomy: a randomized, double-blind, placebo-controlled trial. Clin J Pain. 2018;34(10):918-926. 3. Berkowitz RD, Steinfeld R, Sah AP, et al. Safety and efficacy of perioperative intravenous meloxicam for moderate-to-severe pain management in total knee arthroplasty: a randomized clinical trial. Pain Med. Published online January 27, 2021. doi:10.1093/pm/pnab016 4. Data on file. Baudax Bio. 5. Singla N, Bindewald M, Singla S, et al. Efficacy and safety of intravenous meloxicam in subjects with moderate-to-severe pain following abdominoplasty. Plast Reconstr Surg Glob Open. 2018;6:e1846. doi:10.1097/GOX.0000000000001846 6. Silinsky JD, Marcet JE, Anupindi VR, et al. Preoperative intravenous meloxicam for moderate-to-severe pain in the immediate post-operative period: a phase IIIb randomized clinical trial in 55 patients undergoing primary open or laparoscopic colorectal surgery with bowel resection and/or anastomosis. Pain Manag. 2021;11(1):9-21. doi:10.2217/pmt-2020-0061