This information is intended for US healthcare professionals.

Preoperative Administration in Total Knee ArthroplastyANJESO Reduced Postdischarge Resource Utilization1

ANJESO patients experienced less pain and were ready for discharge sooner, leading to fewer resources utilized vs placebo patients


*Hospital costs included charges for the hospital room, drugs, medical and surgical supplies, sterile supply, laboratory, pathology lab, operating room, anesthesia, recovery room, physical therapy, respiratory therapy, occupational therapy, diagnostics, pulmonary function, and transfusions and blood supply. Charges were converted to costs based on published data.2

ER, emergency room; SNF, skilled nursing facility.

Preoperative Administration in Colorectal SurgeryANJESO Treatment Reduced Time to Discharge Compared to Placebo4

ANJESO Patients Had Lower Mean Adjusted Costs of Hospital Stay Compared to the Placebo Group5

Hospital Visits

Mean length of hospital stay was the time from end of surgery to actual hospital discharge in hours. ANJESO patients had a mean (SD) length of stay of 77.0 hours (7.7) vs 104.6 hours (9.0) for placebo patients (P<0.05).5

Limitations: Results of a single study, which was not powered for all the endpoints described. Study was performed in the controlled settings of a clinical research study, which may not be able to be extrapolated to individual clinical use. Data monitoring board recommended stopping recruitment at interim analysis as primary endpoint was achieved. The differences between study groups were not significant for adjusted mean hospital costs and the trial was not sufficiently powered to detect such differences. A number of the health resource utilization endpoints did not achieve statistical significance likely due to the small size.

Hospital costs included charges for hospital room, drugs, medical/surgical supplies, sterile supply, laboratory, pathology lab, operating room, anesthesia, recovery room (PACU), physical therapy, respiratory therapy, diagnostics, occupational therapy, pulmonary function, and transfusions/blood supply. Outliers (top 99th percentile) removed. Charges were converted to costs based on published data.5

NS, not significant; PACU, post-anesthesia care unit; SD, standard deviation.

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. Berkowitz RD, Steinfeld R, Sah AP, et al. Healthcare resource utilization associated with preoperative meloxicam IV in primary total knee arthroplasty. Poster presented at: 45th Annual Regional Anesthesiology & Acute Pain Medicine Meeting; April 23-25, 2020; San Francisco, CA. 2. Berkowitz RD, Steinfeld R, Sah AP, et al. Efficacy and safety of preoperative meloxicam IV in primary total knee arthroplasty. Poster presented at: 45th Annual Regional Anesthesiology & Acute Pain Medicine Meeting; April 23-25, 2020; San Francisco, CA. 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. 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. 5. Data on file. Baudax Bio.