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Jordan TJM, Bizikova P. Canine and Feline Pemphigus Foliaceus-an Update on Pathogenesis and Treatment. Vet Clin North Am Small Anim Pract 2024:S0195-5616(24)00114-1. [PMID: 39725576 DOI: 10.1016/j.cvsm.2024.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2024]
Abstract
Pemphigus foliaceus (PF) is one of the most common autoimmune skin diseases of dogs and cats and is characterized by the development of pustules, crusts, erosions, scales, and alopecia. Albeit poorly understood, the pathophysiology of canine and feline PF appears to involve immune dysregulation and immunoglobulin G autoantibodies that are directed against the keratinocyte cell surface. At present, the management of canine and feline PF relies on the long-term to lifelong prescription of immunosuppressive medications. Current knowledge on the pathogenesis of canine and feline PF, as well as traditional and emerging therapies used to treat both diseases, will be reviewed herein.
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Affiliation(s)
- Tyler J M Jordan
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA.
| | - Petra Bizikova
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607, USA
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2
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Klotsman M, Anderson WH, Wyatt D, Lewis T, Theus N, Santoro D. Treatment of moderate-to-severe canine atopic dermatitis with modified-release mycophenolate (OKV-1001): A pilot open-label, single-arm multicentric clinical trial. Vet Dermatol 2024; 35:652-661. [PMID: 39129671 DOI: 10.1111/vde.13283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/26/2024] [Accepted: 07/24/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Mycophenolate is an immunomodulating agent successfully used for the treatment of moderate-to-severe atopic dermatitis (AD) in people. Mycophenolate is an effective steroid-sparing treatment option for use in dogs with inflammatory skin diseases. OBJECTIVE To evaluate whether once-daily modified-release mycophenolate (OKV-1001) is safe and effective for treating moderate-to-severe canine AD. ANIMALS Client-owned atopic dogs (n = 9) were enrolled. MATERIALS AND METHODS In an open-label multicentre pilot study, OKV-1001 (30 mg/kg every 24 h) was given orally for ≤84 days. Concomitant tapering doses of glucocorticoids were administered up to Day (D)28. Clinicians assessed Canine Atopic Dermatitis Extent and Severity Index, 4th iteration (CADESI-04) on D0, D14, D28, D56 and D84. Body weight and clinical pathological parameters were measured at baseline and at the end of the study. RESULTS Treatment with OKV-1001 combined with glucocorticoids significantly reduced the severity of AD within two weeks in seven of nine (77.8%) dogs. The mean percentage change from baseline in the CADESI-04 score was 29% (p = 0.009) at D14 (n = 9), 39% (p = 0.008) at D28 (n = 9) and 49% (p = 0.03) at D56 (n = 7) at which point glucocorticoids had been withdrawn. In two dogs the improvement in CADESI-04 was 62% and 23% (respectively) on D84. No significant adverse events including clinical pathological findings were reported. CONCLUSIONS AND CLINICAL RELEVANCE Modified-release mycophenolate (OKV-1001) may represent a promising alternative treatment option for dogs with moderate-to-severe AD. The safety and efficacy profile of OKV-1001 will need to be established in larger, placebo-controlled clinical trials.
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Affiliation(s)
| | - Wayne H Anderson
- Okava Pharmaceuticals, San Francisco, California, USA
- Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Tom Lewis
- Dermatology for Animals, Gilbert, Arizona, USA
| | | | - Domenico Santoro
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
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Tham HL, Davis JL. Pharmacology of drugs used in autoimmune dermatopathies in cats and dogs: A narrative review. Vet Dermatol 2024; 35:453-476. [PMID: 38708551 DOI: 10.1111/vde.13253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/15/2024] [Accepted: 04/12/2024] [Indexed: 05/07/2024]
Abstract
Immunosuppressive drugs are the mainstay of treatment for many feline and canine autoimmune skin diseases, either as monotherapy or in combination with other drugs. Treatment with these drugs is often lifelong and may have long-term consequences on the affected animal's overall quality-of-life. Clinicians need to understand the pharmacology of immunosuppressants in planning and executing the treatment regimen for the best possible clinical outcome, as well as reducing the risk of adverse effects. This review paper will focus on the mechanism of action, pharmacokinetics and pharmacodynamics, clinical uses and adverse effects of immunosuppressive drugs used to treat autoimmune dermatoses in cats and dogs. These include glucocorticoids, ciclosporin A, azathioprine, chlorambucil, mycophenolate mofetil, oclacitinib and Bruton's tyrosine kinase inhibitors.
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Affiliation(s)
- Heng L Tham
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA
| | - Jennifer L Davis
- Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA
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Yun T, Koo Y, Chae Y, Lee D, Kim H, Yang MP, Kang BT, Kang BT. Successful Treatment With Prednisolone and Mycophenolate Mofetil in a Dog With Recurrent Erythema Multiforme Minor. Top Companion Anim Med 2023; 52:100755. [PMID: 36586578 DOI: 10.1016/j.tcam.2022.100755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/12/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
A 3-year-old neutered male miniature poodle dog was referred with a 19-month history of unresolved dermatological signs despite long-term treatment. On physical examination, the dog had severe multifocal erythematous non-blanching patches and scales in the ventral trunk. Dermatological examination revealed Malassezia infection. Considering the history, clinical signs, and degree of infection, the possibility of a drug eruption appeared higher than that of Malassezia dermatitis. Therefore, bathing in lukewarm water was performed for 4 weeks without any other treatment, but there was no improvement. Subsequently, treatment for Malassezia dermatitis and differentiation from allergic dermatitis were performed, but there was still no improvement. A biopsy was performed, with the histopathology revealing lymphocytic interface dermatitis with keratinocyte apoptosis. Based on the histopathologic evaluation and clinical signs, the dog was diagnosed with erythema multiforme (EM) minor. Immunosuppressive therapy with prednisolone (1 mg/kg PO, twice daily) was initiated and had a good therapeutic effect. However, the lesion recurred after tapering the prednisolone dose (0.5 mg/kg PO, every other day). Therefore, steroid-sparing agents were added to the prednisolone regimen. Ciclosporin, azathioprine, and human intravenous immunoglobulin were administered in combination with prednisolone. Yet again, the lesion recurred when the dose of prednisolone was tapered to 0.5 mg/kg once daily. Mycophenolate mofetil (20 mg/kg PO, twice daily) was then added to the immunosuppressive regimen as a steroid-sparing agent, and complete remission was achieved and maintained even when the dose of prednisolone was tapered to 0.5 mg/kg every other day. This is the first reported case of recurrent EM successfully treated with a combination of prednisolone and mycophenolate mofetil, and this treatment option should be considered for recurrent EM.
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Affiliation(s)
- Taesik Yun
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, South Korea
| | - Yoonhoi Koo
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, South Korea
| | - Yeon Chae
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, South Korea
| | - Dohee Lee
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, South Korea
| | - Hakhyun Kim
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, South Korea
| | - Mhan-Pyo Yang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, South Korea
| | - Byeong-Teck Kang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, South Korea.
| | - Byeong-Teck Kang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk 28644, South Korea.
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Burroughs DL, Lorch G, Guo Y, Hill K, Schroeder EL, Cole LK, Phelps MA. Noncompartmental pharmacokinetics of three intravenous mycophenolate mofetil concentrations in healthy Standardbred mares. Vet Dermatol 2022; 34:222-234. [PMID: 35929548 DOI: 10.1111/vde.13109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/10/2022] [Accepted: 05/24/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mycophenolate mofetil (MMF) is the prodrug of mycophenolic acid (MPA) which acts as an immunosuppressive agent. During the biotransformation of MMF to MPA, additional metabolites including MPA phenol glucuronide (MPAG), MPA acyl glucuronide (AcMPAG) and MPA phenol glucoside (MPG) are formed. OBJECTIVE To define the noncompartmental pharmacokinetic (PK) parameters of three single doses of intravenous (i.v.) MMF and its downstream metabolites in healthy horses. ANIMALS Six healthy Standardbred mares. MATERIALS AND METHODS Generic MMF (Par Pharmaceuticals; Chestnut Ridge, NY, USA) was reconstituted and administered as a single i.v. bolus at 1.0 mg/kg, 5.0 mg/kg and 10.0 mg/kg with an eight day washout between treatments. Blood samples were collected immediately before MMF administration and over 24 h. A liquid chromatography-tandem mass spectrometry assay was developed following FDA guidance to determine plasma MMF, MPA, MPAG, AcMPAG and MPG concentrations. Plasma concentrations were analysed independently, followed by calculation of geometric mean and coefficient of variation. RESULTS Noncompartmental PK parameters were determined for MMF and all metabolites at all doses. MMF was rapidly converted to MPA in all horses. Each incremental dose of MMF resulted in increases in Cmax and AUCinf _obs for MPA and the three additional metabolites. Within the 10-fold dose range, the increase in Cmax and AUCinf _obs for MMF and its metabolites was nonlinear. CONCLUSIONS AND CLINICAL RELEVANCE Horses biotransform MMF into MPA, MPAG, AcMPAG and MPG via the glucuronidation and glucosidation clearance pathways. Equine reference PK profiles for MPA and the metabolites, MPAG, AcMPAG and MPG were established.
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Affiliation(s)
- Dylan L Burroughs
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Gwendolen Lorch
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Yizhen Guo
- Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Kasey Hill
- Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Eric L Schroeder
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Lynette K Cole
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Mitch A Phelps
- Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, Columbus, OH, USA
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Glucocorticoids, Cyclosporine, Azathioprine, Chlorambucil, and Mycophenolate in Dogs and Cats. Vet Clin North Am Small Anim Pract 2022; 52:797-817. [DOI: 10.1016/j.cvsm.2022.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Chong E, Austel M, Banovic F. A Retrospective Evaluation of the Steroid-Sparing Effect of Oral Modified Ciclosporin for Treatment of Canine Pemphigus Foliaceus. Vet Sci 2022; 9:vetsci9040153. [PMID: 35448651 PMCID: PMC9029188 DOI: 10.3390/vetsci9040153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/10/2022] [Accepted: 03/21/2022] [Indexed: 02/06/2023] Open
Abstract
The efficacy of ciclosporin as an adjuvant immunosuppressant administered with glucocorticoids (GCs) for induction of canine PF remission is unknown. This study is a retrospective review of medical records from 2015 to 2020 to evaluate the therapeutic outcomes of 11 PF dogs treated with oral modified ciclosporin and GCs. Concurrent GCs were given with ciclosporin to all PF dogs. Nine dogs (9/11) achieved complete remission (CR); five dogs received ciclosporin at a mean dose of 6.2 mg/kg/day; and four dogs received a combination of ciclosporin and ketoconazole at a mean dose of 3 mg/kg/day, respectively. Two dogs (2/11) showed only 25% or poor response, with the development of new PF lesions during treatment. The mean duration of ciclosporin therapy for nine dogs to achieve CR was 65 days (median 57 days, range 24–119 days). Slow tapering of oral GCs while continuing ciclosporin at the same dose and frequency in nine dogs with CR led to recurrence of PF lesions in four dogs, whereas, in five dogs, oral glucocorticoids were discontinued without a PF flare. Oral modified ciclosporin combined with GCs achieved CR in 9 out of 11 PF dogs during the induction phase in this study.
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Putra A, Austel M, Banovic F. A retrospective evaluation of the steroid sparing effects of oral mycophenolate mofetil (MMF) as an adjunct immunosuppressant for the treatment of canine pemphigus foliaceus. Vet Dermatol 2021; 33:77-e24. [PMID: 34697841 DOI: 10.1111/vde.13028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Oral mycophenolate mofetil (MMF) is currently considered a low-risk steroid-sparing therapeutic option the management of canine pemphigus foliaceus (PF). OBJECTIVES This retrospective study evaluates the therapeutic outcomes of dogs with PF treated with the combination of oral MMF and GC. Clinical outcomes and side effects are reported. ANIMALS Eleven dogs diagnosed with PF. METHODS AND MATERIALS Retrospective review of medical records from dogs presented with PF to the dermatology service of a veterinary teaching hospital 2015-2020. RESULTS Eleven dogs were identified which had received concurrent GCs and MMF. The MMF dose range was 19.8-45 mg/kg/day. Only two dogs (2/11) treated with a mean MMF dosage of 39 mg/kg/day along with oral prednisone or dexamethasone achieved complete remission (CR). Partial remission (PR) was achieved in 4/11 dogs who received either prednisone, prednisolone or dexamethasone along with MMF (mean dosage 26 mg/kg/day). Four dogs (4/11) showed poor response to MMF given at 28.5 mg/kg/day along with prednisone or dexamethasone. In one dog (1/11) MMF was discontinued due to severe GI upset; transient vomiting and diarrhea was observed in 4/11 dogs. The median duration of MMF therapy in conjunction with GC for all groups was 70.5 days. Tapering of oral GCs while continuing MMF administration at the same dosage and frequency led to recurrence of lesions in all PF patients. CONCLUSION Oral MMF combined with GC achieved CR in 2 out of 11 PF dogs included in this study. Further research of MMF efficacy in PF may need to be performed.
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Affiliation(s)
- Andhika Putra
- Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, Athens, GA, USA
| | - Michaela Austel
- Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, Athens, GA, USA
| | - Frane Banovic
- Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, Athens, GA, USA
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Eberhardy A, Heinrich N, McFadden R, Reiter L. Combination therapy with mycophenolate mofetil and prednisone for exfoliative cutaneous lupus erythematosus in a German shorthaired pointer dog. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | | | | | - Lisa Reiter
- McKeever Dermatology Clinics Eden Prairie Minnesota USA
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Li Puma MC, Diehl KA. The use of systemic mycophenolate in canine immune‐mediated ophthalmic disease. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Margaret C. Li Puma
- Department of Small Animal Medicine and Surgery University of Georgia College of Veterinary Medicine Athens Georgia USA
| | - Kathryn A. Diehl
- Department of Small Animal Medicine and Surgery University of Georgia College of Veterinary Medicine Athens Georgia USA
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Barber KF, Loughin CA, Marino DJ, Lesser M. The Effects of Mycophenolate on the Formation of Granulation Tissue Post-operatively in Canine Tracheal Stent Patients (2014-2020). Front Vet Sci 2021; 8:697513. [PMID: 34414226 PMCID: PMC8370251 DOI: 10.3389/fvets.2021.697513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/02/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To determine if mycophenolate mofetil reduces the incidence and severity of granulation tissue in-growth in canine tracheal stent patients. Study design: Randomized clinical trial. Animals: 111 dogs from the hospital population. Methods: Client-owned dogs that received an endoluminal self-expanding tracheal stent for canine tracheal collapse between 2014 and 2020 were randomly assigned into one of two treatment groups. Control group medication protocol consisted of prednisone 0.5 mg/kg PO BID/SID/EOD × 30 days, hydrocodone 0.25 mg/kg PO TID × 30 days, and cefovecin 8 mg/kg SQ post-placement. Mycophenolate group medication protocol was identical to the control group medication protocol with the addition of mycophenolate mofetil 10 mg/kg PO BID × 30 days, SID for life. Recheck tracheoscopy was performed at 1, 3, and 6 months post-stent placement. Presence and severity of granulation tissue were determined by tracheoscopy and were recorded as a percentage of tracheal lumen obstruction by blinded evaluators (none present, <25%, >25-50%, and >50%). Results: At none of the three time points was there a statistically significant difference in grade between controls and those receiving mycophenolate (p = 0.467, p = 0.330, and p = 0.410). Conclusions and Clinical Significance: Our results suggest that mycophenolate can be safely given to these patients but do not support that its administration will reduce the incidence and severity of granulation tissue. Although a difference was observed in the severity of granulation tissue between the two groups, loss to follow-up may have influenced conclusions. A larger study would be warranted to further evaluate the effect of mycophenolate on the development of granulation tissue.
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Affiliation(s)
- Kevin F Barber
- Department of Surgery, Long Island Veterinary Specialists, Plainview, NY, United States
| | - Catherine A Loughin
- Department of Surgery, Long Island Veterinary Specialists, Plainview, NY, United States
| | - Dominic J Marino
- Department of Surgery, Long Island Veterinary Specialists, Plainview, NY, United States
| | - Martin Lesser
- Biostatistics Unit, Feinstein Institute for Medical Research, Northwell Healthy, Great Neck, NY, United States
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Fukushima K, Lappin M, Legare M, Veir J. A retrospective study of adverse effects of mycophenolate mofetil administration to dogs with immune-mediated disease. J Vet Intern Med 2021; 35:2215-2221. [PMID: 34231261 PMCID: PMC8478029 DOI: 10.1111/jvim.16209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 06/11/2021] [Accepted: 06/18/2021] [Indexed: 01/20/2023] Open
Abstract
Background Information regarding adverse events (AEs) of mycophenolate mofetil (MMF) is limited. Objectives To evaluate the types and frequency of potential AEs of MMF in dogs with immune‐mediated disease. Animals One hundred thirty‐one dogs treated with MMF for management of suspected immune‐mediated disease. Methods Retrospective study. Medical records were reviewed to find and group suspect AEs in gastrointestinal (GI), hematologic, and other categories. Age, dosage, body weight, and sex were analyzed between dogs with and without AEs by using the Mann‐Whitney U‐test and chi‐squared test. Results The median starting dosage of MMF was 17.5 mg/kg/day (interquartile range [IQR] = 15.1‐20.6 mg/kg/day) and the median treatment duration was 56 days (IQR = 14‐236 days). Mycophenolate mofetil was prescribed for immune‐mediated hemolytic anemia (n = 31), immune‐mediated thrombocytopenia (n = 31), pemphigus foliaceus (n = 15), immune‐mediated polyarthritis (n = 12), and others (n = 42). Overall, potential AEs of MMF were observed in 34 of 131 dogs (GI 24.4% [31/127], neutropenia 4% [3/76], anemia 4% [1/25], thrombocytopenia 4.0% [1/25], and dermatologic 1.5% [2/131]). There were no significant differences among dogs with (n = 37) or without potential AEs (n = 94) in regards to sex, age, body weight, or dosage of MMF (P = .06, .13, .24, and .26, respectively). Conclusions and Clinical Importance In the dogs administered MMF, GI AEs were most common. Since potential hematologic and dermatologic AEs developed in a few dogs, clinicians should be aware of these when prescribing MMF to dogs with immune‐mediated disease.
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Affiliation(s)
- Kenjiro Fukushima
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Michael Lappin
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Marie Legare
- Department of Environmental and Radiological Health Science, Colorado State University, Fort Collins, Colorado, USA
| | - Julia Veir
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
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Knych HK, McKemie DS, Kanarr KL, White SD. Pharmacokinetics of mycophenolate mofetil following single-dose intravenous and single- and multiple-dose oral administration and clinicopathologic effects of mycophenolate mofetil following long-term oral administration in healthy horses. Am J Vet Res 2021; 82:502-509. [PMID: 34032479 DOI: 10.2460/ajvr.82.6.502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize the pharmacokinetics of mycophenolate mofetil (MMF) following single-dose IV or PO administration, characterize the pharmacokinetics of MMF following long-term PO administration, and describe the clinicopathologic effects of long-term MMF administration in horses. ANIMALS 12 healthy adult horses. PROCEDURES In phase 1, 6 horses received a single IV (2.5 mg/kg) or PO (5 mg/kg) dose of MMF in a randomized balanced crossover assessment (≥ 2-week interval between administrations). In phase 2, 6 other horses received MMF for 60 days (5 mg/kg, PO, q 24 h for 30 days and then 5 mg/kg, PO, q 48 h for an additional 30 days). RESULTS Following IV (single-dose) or PO (single- or multiple-dose) administration, MMF was rapidly converted to mycophenolic acid. For single-dose PO administration, mean ± SD maximum plasma mycophenolic acid concentration was 1,778.3 ± 441.5 ng/mL at 0.71 ± 0.29 hours. For single-dose IV administration, mean systemic clearance and volume of distribution at steady state were 0.689 ± 0.194 L/h/kg and 1.57 ± 0.626 L/kg, respectively. Following single doses, mean terminal half-life was 3.99 ± 0.865 hours for IV administration and 4.02 ± 1.01 hours for PO administration. The accumulation index following long-term PO administration was 1.0 ± 0.002, and the terminal half-life was 4.59 ± 1.25 hours following the final dose on day 60. None of the horses developed abnormal clinical signs or had any consistently abnormal clinicopathologic findings. CONCLUSIONS AND CLINICAL RELEVANCE Further investigation of the clinical efficacy of long-term MMF treatment of horses with autoimmune diseases is warranted.
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Successful Treatment of Mucocutaneous Lupus Erythematosus in a Dog with Prednisolone, Mycophenolate Mofetil and Tacrolimus. Vet Sci 2021; 8:vetsci8050072. [PMID: 33922817 PMCID: PMC8146856 DOI: 10.3390/vetsci8050072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 11/16/2022] Open
Abstract
A 6-year-old, intact male miniature Pinscher dog had erosive lesions on perilabial, peripenial and perianal mucocutaneous areas, which were exacerbated by ulcerations, crusts, with pain while defecating and urinating. The lesions were symmetrical, and no systemic signs were observed. Histopathological evaluation showed parakeratotic hyperkeratosis, ulceration and cell-rich lymphoplasmacytic interface dermatitis with basal keratinocyte apoptosis. Immunohistochemistry revealed strong reaction in the dermoepidermal junction against goat-canine IgG and mild-to-moderate reaction against goat-canine IgA, IgM and C3. Based on these findings, the dog was diagnosed with mucocutaneous lupus erythematosus (MCLE). Oral prednisolone 1 mg/kg twice daily, mycophenolate mofetil (MMF) 18.3 mg/kg twice daily and 0.1% tacrolimus ointment were prescribed as initial treatment. The lesions showed remarkable improvement within 4 weeks, but the dog exhibited polyuria, polydipsia and hepatomegaly with high dosage of prednisolone. Hence, the dosage of prednisolone was gradually tapered for 9 weeks and discontinued, but MMF and tacrolimus were continued. No new lesion or associated side effect was observed while reducing the MMF dose to 10 mg/kg twice daily and with continuous use of tacrolimus ointment after steroid discontinuation. In conclusion, this case report emphasizes the usefulness of MMF and tacrolimus as steroid-sparing agents in the treatment of dogs with MCLE. To the best of our knowledge, this is the first case report of MCLE that was successfully managed long-term with MMF and tacrolimus.
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Klotsman M, Sathyan G, Anderson WH. Single-dose pharmacokinetics of mycophenolic acid following administration of immediate-release mycophenolate mofetil in healthy Beagle dogs. J Vet Pharmacol Ther 2021; 44:650-656. [PMID: 33580714 DOI: 10.1111/jvp.12950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/10/2021] [Accepted: 01/19/2021] [Indexed: 02/06/2023]
Abstract
Mycophenolic acid (MPA) is an immunomodulating agent commonly used in human medicine for the treatment of immune-mediated diseases. There is growing evidence that the immunomodulating properties of mycophenolate mofetil (MMF), a prodrug of MPA, are therapeutically beneficial for the treatment of immune-mediated diseases in dogs. A narrow therapeutic index and high inter-and intra-patient pharmacokinetic (PK) variability complicate the use of MMF. A better characterization of MPA pharmacokinetics is needed to help establish dosing regimens and standardized treatment protocols for canine patients. The purpose of this study was to evaluate the pharmacokinetics of MPA in dogs. MMF oral suspension (10 mg/kg) was administered to five healthy beagle dogs. Serial blood samples were collected from 0 to 18 hours after administration. The simultaneous quantification of MPA, and its metabolites MPA-7-O-glucuronide (MPAG), and acyl glucuronide (AcMPAG) was determined by liquid chromatography (LC)-mass spectrometry (MS)/MS. MPA peak concentrations were achieved rapidly (median Tmax of 0.5 h). Concentrations fell through 3 hours post-dose and then plateaued around 20% of Cmax. The mean elimination half-life was rapid (5.8 hours) and notable variability was observed in all PK parameters. The PK profiles for the MPAG and AcMPAG metabolites followed a similar pattern as MPA concentration. Future repeat-dose studies will be needed to evaluate steady-state PK parameters and to define therapeutic MPA dose levels.
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Affiliation(s)
| | | | - Wayne H Anderson
- Okava Pharmaceuticals, San Francisco, CA, USA.,Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Marchegiani A, Tambella AM, Fruganti A, Spaterna A, Cerquetella M, Paterson S. Management of canine perianal fistula with fluorescence light energy: preliminary findings. Vet Dermatol 2020; 31:460-e122. [PMID: 32914496 DOI: 10.1111/vde.12890] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 06/24/2020] [Accepted: 06/27/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Canine perianal fistula (CPF) is a severe, painful, debilitating skin condition affecting the perianal skin. It often interferes with the quality of life of both dog and owner. Conventional medical treatment involves the use of immunosuppressive therapy; however, the successful resolution of lesions can be limited by poor owner compliance, adverse drug effects and dependence on costly therapies. HYPOTHESIS/OBJECTIVES The present study aimed to assess the potential benefits of fluorescent light energy (FLE) on cases of CPF. ANIMALS Four dogs with active perianal fistulas METHODS AND MATERIALS: FLE was applied as sole management therapy once a week with two consecutive applications in the same session for each dog until clinical signs had significantly improved, with weekly assessments for a six week period. Dogs were assessed by measuring the size of lesions at the start of the study and then weekly for six weeks, using planimetry software. Owners recorded vocalization and straining frequency scores during their pet's defaecation, and perianal licking frequency on a 0-5 point scale to assess the response to therapy. RESULTS All dogs improved with FLE, achieving a significant reduction in vocalization, straining and licking after two weeks (P = 0.002). After five weeks of FLE therapy, lesional areas had significantly decreased (P = 0.04). Only one dog required more than seven applications. No adverse events were reported. CONCLUSION AND CLINICAL IMPORTANCE FLE may be a promising alternative therapy for CPF.
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Affiliation(s)
- Andrea Marchegiani
- School of Biosciences and Veterinary Medicine, University of Camerino, via Circonvallazione 93/95, Matelica, Marche, I-62024, Italy
| | - Adolfo M Tambella
- School of Biosciences and Veterinary Medicine, University of Camerino, via Circonvallazione 93/95, Matelica, Marche, I-62024, Italy
| | - Alessandro Fruganti
- School of Biosciences and Veterinary Medicine, University of Camerino, via Circonvallazione 93/95, Matelica, Marche, I-62024, Italy
| | - Andrea Spaterna
- School of Biosciences and Veterinary Medicine, University of Camerino, via Circonvallazione 93/95, Matelica, Marche, I-62024, Italy
| | - Matteo Cerquetella
- School of Biosciences and Veterinary Medicine, University of Camerino, via Circonvallazione 93/95, Matelica, Marche, I-62024, Italy
| | - Susan Paterson
- Virtual Vet Derms Ltd., Lakeview, 3 High Birkrigg Park, Stainton, Kendal, LA8 0DY, UK
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17
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Günther C, Steffen F, Alder DS, Beatrice L, Geigy C, Beckmann K. Evaluating the use of cytosine arabinoside for treatment for recurrent canine steroid-responsive meningitis-arteritis. Vet Rec 2020; 187:e7. [PMID: 33638531 PMCID: PMC7456679 DOI: 10.1136/vr.105683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/17/2019] [Accepted: 01/29/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Relapses in steroid-responsive meningitis-arteritis (SRMA) are frequently observed but specific treatment protocols to address this problem are sparsely reported. Standard treatment includes prolonged administration of glucocorticoids as monotherapy or in combination with immunosuppressive drugs. The aim of this study was to assess the safety and efficacy of cytosine arabinoside (CA) in combination with glucocorticoids for treatment of SRMA relapses in 12 dogs on a retrospective basis. METHODS Dogs with recurrent episodes of SRMA and treated with a combination of CA and prednisolone were included. Information about clinical course, treatment response and adverse events was collected from medical records. Ethical approval was not required for this study. RESULTS Ten dogs (10/12) responded well to the treatment with clinical signs being completely controlled. One dog is in clinical remission, but still under treatment. One dog (8%) showed further relapse. Mean treatment period was 51 weeks. Adverse events of variable severity (grade 1-4/5) were documented in all dogs during treatment according to the veterinary cooperative oncology group grading. Three dogs developed severe adverse events. Laboratory findings showed marked changes up to grade 4. Diarrhoea and anaemia were the most often observed adverse events (6), followed by dermatitis (4), alopecia (3) and pneumonia (3). Including blood chemistry changes (13), 50 adverse events were found in total. CONCLUSION Treatment with CA and glucocorticoids resulted in clinical remission in 10/12 dogs, but a high incidence of adverse events occurred requiring additional measures. All adverse events could be managed successfully in all cases.
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Affiliation(s)
- Christian Günther
- Clinic of Small Animal Surgery/Neurology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Frank Steffen
- Clinic of Small Animal Surgery/Neurology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Daniela S Alder
- Clinic of Small Animal Surgery/Neurology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Neurology/Neurosurgery, Southern Counties Veterinary Specialists LLP, Ringwood, Hampshire, UK
| | - Laura Beatrice
- Department fur Kleintiere, Oncology, Universitat Zurich, Zurich, Switzerland
| | - Caroline Geigy
- Department fur Kleintiere, Oncology, Universitat Zurich, Zurich, Switzerland
- Departmend of Internal Medicine, Marigin - Zentrum für Tiermedizin, Feusisberg, Switzerland
| | - Katrin Beckmann
- Clinic of Small Animal Surgery/Neurology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Department fur Kleintiere, Oncology, Universitat Zurich, Zurich, Switzerland
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18
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Song JH, Yu DH, Lee HC, Hwang TS, Kim YJ, An SJ, Jung DI. Evaluation of treatment with a combination of mycophenolate mofetil and prednisolone in dogs with meningoencephalomyelitis of unknown etiology: a retrospective study of 86 cases (2009-2017). BMC Vet Res 2020; 16:192. [PMID: 32532259 PMCID: PMC7291637 DOI: 10.1186/s12917-020-02414-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Combination therapy with glucocorticoids and adjunctive immunomodulating drugs has been generally accepted as a standard treatment regimen for meningoencephalomyelitis of unknown etiology (MUE). We hypothesized that treatment with MMF as an adjunctive agent along with glucocorticoids would be effective and well-tolerated protocol in dogs with MUE. Eighty-six dogs with MUE between May 2009 and June 2017 were included (59 females and 27 males; mean age of 5.93 years; mean body weight of 3.83 kg). The medical records of dogs with MUE treated with prednisolone and MMF were retrospectively evaluated to determine the therapeutic response, survival time, and treatment-related adverse effects. RESULTS A partial or complete response (CR) was recorded for 75 dogs. The overall median survival time from the initiation of treatment was 558 days. Dogs that showed CR with no relapse over the treatment period (from diagnosis to death) had significantly longer median survival times. A significantly higher mortality hazard ratio of 4.546 was recorded in dogs that failed to achieve CR. The interval between the onset of clinical signs and the clinical presentation was not significantly associated with CR, relapse rate, and survival time. Adverse effects included gastrointestinal upsets in 26 dogs (30.23%), sporadic infections in 17 dogs (19.77%), and pancreatitis in seven dogs (8.14%). CONCLUSIONS The results suggest that adjunctive MMF treatment for MUE is safe and comparable to other immunosuppressive protocols. The treatment should focus on the achievement of CR and preventing relapse for successful management.
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Affiliation(s)
- Joong-Hyun Song
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, South Korea
| | - Do-Hyeon Yu
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, South Korea
| | - Hee-Chun Lee
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, South Korea
| | - Tae-Sung Hwang
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, South Korea
| | - Young Joo Kim
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, California, 91766-1854, USA
| | - Su-Jin An
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, South Korea
| | - Dong-In Jung
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, South Korea.
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19
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Ferrigno A, Hoover K, Blubaugh A, Rissi D, Banovic F. Treatment of exfoliative cutaneous lupus erythematosus in a German shorthaired pointer dog with mycophenolate mofetil. Vet Dermatol 2019; 30:350-e102. [PMID: 31038261 DOI: 10.1111/vde.12747] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Immune-modulating drugs show limited therapeutic efficacy in canine exfoliative cutaneous lupus erythematosus (ECLE); over half of ECLE dogs are eventually euthanized for their lack of response to therapy. OBJECTIVE To describe a case of generalized ECLE in a dog in which mycophenolate mofetil (MMF) treatment achieved complete remission. ANIMAL A 3-year-old, male castrated German shorthaired pointer was presented with a three months history of generalized scaling, erythematous macules and plaques, follicular casts and hypotrichosis affecting the head, trunk, ventrum and medial aspects of all limbs. The dog exhibited lameness and stiff gait. METHODS AND MATERIALS Complete blood count, serum chemistry profile, urinalysis, serum antinuclear antibody test, histopathological examination and RT-qPCR of skin biopsies. RESULTS Histologically, skin biopsy specimens revealed lymphocyte-rich interface dermatitis, infundibular interface mural folliculitis and periglandular lymphocytic infiltrate. The absence of systemic signs and unremarkable laboratory tests excluded concurrent systemic lupus erythematosus. Treatment of ECLE was initiated with oral MMF (22 mg/kg, twice daily). Within three weeks of starting MMF therapy, a marked improvement in lameness and a moderate decrease in erythema and scaling was observed. After four months, erythema, scaling and follicular casts had completely resolved, and at the time of writing the dog's ECLE remains in complete remission with twice daily MMF (10 mg/kg). The lesional skin transcriptome revealed predominant T helper 1 (Th1) lymphocytic inflammatory response with strong upregulation of interferon pathway. CONCLUSIONS AND CLINICAL IMPORTANCE To the best of the authors' knowledge, this is the first reported case of successful treatment of ECLE with MMF as a single-agent therapy.
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Affiliation(s)
- Alena Ferrigno
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, 2200 College Station Road, Athens, GA, 30602, USA
| | - Kathleen Hoover
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, 2200 College Station Road, Athens, GA, 30602, USA
| | - Amanda Blubaugh
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, 2200 College Station Road, Athens, GA, 30602, USA
| | - Daniel Rissi
- Department of Pathology, College of Veterinary Medicine, University of Georgia, 501 D.W. Brooks Drive, Athens, GA, 30602, USA
| | - Frane Banovic
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, 2200 College Station Road, Athens, GA, 30602, USA
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20
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Swann JW, Garden OA, Fellman CL, Glanemann B, Goggs R, LeVine DN, Mackin AJ, Whitley NT. ACVIM consensus statement on the treatment of immune-mediated hemolytic anemia in dogs. J Vet Intern Med 2019; 33:1141-1172. [PMID: 30847984 PMCID: PMC6524099 DOI: 10.1111/jvim.15463] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/06/2019] [Indexed: 01/07/2023] Open
Abstract
Immune‐mediated hemolytic anemia (IMHA) causes severe anemia in dogs and is associated with considerable morbidity and mortality. Treatment with various immunosuppressive and antithrombotic drugs has been described anecdotally and in previous studies, but little consensus exists among veterinarians as to the optimal regimen to employ and maintain after diagnosis of the disease. To address this inconsistency and provide evidence‐based guidelines for treatment of IMHA in dogs, we identified and extracted data from studies published in the veterinary literature. We developed a novel tool for evaluation of evidence quality, using it to assess study design, diagnostic criteria, explanation of treatment regimens, and validity of statistical methods. In combination with our clinical experience and comparable guidelines for humans afflicted with autoimmune hemolytic anemia, we used the conclusions of this process to make a set of clinical recommendations regarding treatment of IMHA in dogs, which we refined subsequently by conducting several iterations of Delphi review. Additionally, we considered emerging treatments for IMHA in dogs and highlighted areas deserving of future research. Comments were solicited from several professional bodies to maximize clinical applicability before the recommendations were submitted for publication. The resulting document is intended to provide clinical guidelines for management of IMHA in dogs. These guidelines should be implemented pragmatically, with consideration of animal, owner, and veterinary factors that may vary among cases.
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Affiliation(s)
- James W Swann
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, United Kingdom
| | - Oliver A Garden
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Claire L Fellman
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts
| | - Barbara Glanemann
- Royal Veterinary College, University of London, London, United Kingdom
| | - Robert Goggs
- College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - Dana N LeVine
- College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Andrew J Mackin
- College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi
| | - Nathaniel T Whitley
- Davies Veterinary Specialists, Manor Farm Business Park, Huntingdon, United Kingdom
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Klotsman M, Sathyan G, Anderson WH, Garden OA, Shivanand P. Mycophenolic acid in patients with immune-mediated inflammatory diseases: From humans to dogs. J Vet Pharmacol Ther 2018; 42:127-138. [PMID: 30375004 DOI: 10.1111/jvp.12731] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 12/26/2022]
Abstract
Mycophenolic acid (MPA), a noncompetitive, selective and reversible inhibitor of inosine 5'-monophosphate dehydrogenase (IMPDH), is an immunosuppressive agent that has a long history in medicine. Mechanistically, the inhibition of IMPDH leads to the selective and eventual arrest of T- and B-lymphocyte proliferation. Mycophenolate mofetil (MMF), the first MPA-based product to receive marketing approval over two decades ago, was originally indicated for the prophylaxis of organ rejection in human transplant patients. Given its broad immunosuppressive properties and ability to selectively inhibit lymphocyte division and effector functions, the clinical utility of MPA was subsequently explored in a host of autoimmune diseases. Human clinical studies have shown MPA to be safe and effective and support its off-label administration for immune-mediated diseases such as lupus, myasthenia gravis and atopic dermatitis. MMF became generically available in the United States in 2008, and its clinical utility is increasingly being explored as a treatment option for dogs with immune-mediated diseases. This review summarizes the available literature for MPA pharmacokinetics and pharmacodynamics, and the current status of MPA as a treatment for client-owned dogs diagnosed with immune-mediated diseases.
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Affiliation(s)
| | | | - Wayne H Anderson
- Okava Pharmaceuticals, San Francisco, California.,Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Oliver A Garden
- Clinical Sciences & Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania
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22
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Elliott J, Villiers E. Indolent, T-cell, large granular lymphocytic leukaemia in a dog presenting with severe neutropenia and an absence of lymphocytosis. Open Vet J 2018; 8:118-124. [PMID: 29721441 PMCID: PMC5918120 DOI: 10.4314/ovj.v8i2.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 03/21/2018] [Indexed: 11/23/2022] Open
Abstract
In humans, large granular lymphocytic leukaemia (LGLL) is a low-grade, indolent lymphoproliferative disorder of large granular lymphocytes (LGL) associated with autoimmune disorders; including rheumatoid arthritis and single or multiple cytopenias; particularly neutropenia. Therapy largely centres around immunosuppression which aims to resolve the immune-mediated secondary pathology, often without eradicating the neoplastic clone. The most effective agents appear to be cyclophosphamide, cyclosporine and methotrexate. This case report describes the presentation, diagnostics, therapeutic approach and outcome of a 6 year-old Golden Retriever presenting with severe neutropenia. Chlorambucil, prednisolone and cyclosporine failed to improve the neutropenia but subsequent cyclophosphamide resulted in a sustained albeit temporary improvement in neutrophil count and the ability to withdraw prophylactic antibacterials. This case closely mirrors the diagnostics and therapeutic response in human LGLL.
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Affiliation(s)
- James Elliott
- Willows Veterinary Centre & Referral Service, Highlands Road, Solihull, B90 4NH, UK
| | - Elizabeth Villiers
- Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Cambridgeshire, CB8 0UH, UK
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23
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Morassi A, Rivera-Vélez SM, Slovak JE, Court MH, Villarino NF. Ex vivo binding of the immunosuppressant mycophenolic acid to dog and cat plasma proteins and the effect of co-incubated dexamethasone and prednisolone. J Vet Pharmacol Ther 2018; 41:513-521. [PMID: 29687456 DOI: 10.1111/jvp.12507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/26/2018] [Indexed: 11/30/2022]
Abstract
Mycophenolic acid (MPA) has been shown to be promising for the treatment of autoimmune diseases in dogs and cats. In humans, MPA is highly bound to plasma proteins (~97%). It has been recommended to monitor free drug plasma concentrations because the free MPA correlates with its immunosuppressive effect. However, it is unknown if MPA is highly bound to plasma proteins in dogs and cats. The objectives of this study were to determine the extent of plasma protein binding of MPA and evaluate the effect of prednisolone and dexamethasone on the extent of protein binding of MPA in dogs and cats. The extent of plasma protein binding of MPA was determined in plasma collected from clinically healthy adult cats (n = 13) and dogs (n = 14) by combining high-throughput dialysis and ultra-high-liquid chromatography. This study reveals that MPA is highly bound to plasma proteins (>90%) in dogs and cats, mean extent of binding of MPA at 15 μg/ml to plasma proteins being 96% (range, 95%-97%) and 92% (range, 90%-93%) for dogs and cats, respectively. In dog plasma, MPA is primarily bound to albumin. In vitro, prednisolone increased the unbound MPA in dogs (p < .01) but not in cats (p = .07) while dexamethasone had no effect on MPA plasma binding in either species (p > .05). Results of this study provide valuable information for designing future pharmacokinetic and pharmacodynamic studies and also therapeutic monitoring programs for dogs and cats.
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Affiliation(s)
- A Morassi
- Department of Veterinary Clinical Sciences, Program in Individualized Medicine, Washington State University, Pullman, Washington
| | - S M Rivera-Vélez
- Department of Veterinary Clinical Sciences, Program in Individualized Medicine, Washington State University, Pullman, Washington
| | - J E Slovak
- Department of Veterinary Clinical Sciences, Program in Individualized Medicine, Washington State University, Pullman, Washington
| | - M H Court
- Department of Veterinary Clinical Sciences, Program in Individualized Medicine, Washington State University, Pullman, Washington
| | - N F Villarino
- Department of Veterinary Clinical Sciences, Program in Individualized Medicine, Washington State University, Pullman, Washington
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