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Lavan R, Normile D, Husain I, Singh A, Armstrong R, Heaney K. An assessment of canine ectoparasiticide administration compliance in the USA. Parasit Vectors 2022; 15:32. [PMID: 35062996 PMCID: PMC8780395 DOI: 10.1186/s13071-021-05134-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022] Open
Abstract
Background This study evaluated the timing of dog owner ectoparasiticide purchases to estimate administration compliance and assess the consequent impact of dose purchase gaps on the proportion of time that dogs were protected over a 12-month period. Methods Ectoparasiticide purchase transactions over a 12-month period were evaluated for 626 US veterinary hospitals to determine dose purchase timing and identify consequent gaps between dose administration in dogs. Orally administered prescription ectoparasitic medications with active ingredients from the isoxazoline family (afoxolaner, fluralaner, lotilaner, or sarolaner) were included in the analysis. A period was calculated for each of the four isoxazoline-containing medications that represented the duration of protection provided by two doses of ectoparasiticide plus the average gap between these two doses. The maximum percentage of time possible for ectoparasiticide protection for this aggregate period was then calculated for each active ingredient. Results Ectoparasiticide transaction records of owners were analyzed for 506,637 dogs. These showed that 43% of dog owners purchased just one dose over the 12-month period considered. If a dog owner purchased more than one dose, then the timing of their transactions could create a time gap between the completion of ectoparasite protection from the first dose and onset of protection from the subsequent purchase and administration of the second dose. Such gaps were observed in purchases made by 31–65% of dog owners, depending on the selected active ingredient and number of doses. The average gap duration between dose purchases was calculated for all possible dose combinations over 12 months of ectoparasite protection. Time gaps between the first and second doses are as follows: for sarolaner, 20.3 weeks; for afoxolaner, 12.9 weeks; for fluralaner ,12.8 weeks; and for lotilaner, 8.9 weeks. The proportion of time when protection was provided during the aggregate period between administration of the first and second doses was as follows: for fluralaner, 65%; for lotilaner, 49%; for afoxolaner, 40%; and for sarolaner, 30%. Conclusions Dog owner ectoparasiticide purchase transactions showed that there were time gaps between doses leading to reduced ectoparasite protection. The longer re-administration interval for fluralaner, a consequence of its extended duration of activity, resulted in dog owners gaining the greatest proportion of ectoparasite protection time with this medication compared with shorter-acting monthly re-treatment medications. Graphical Abstract ![]()
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Cvejić D, Hellmann K, Petry G, Ringeisen H, Hamburg H, Farkas R, Blazejak K, Mencke N. Multicenter randomized, and blinded European field study evaluating the efficacy and safety of Felpreva®, a novel spot-on formulation containing emodepside, praziquantel and tigolaner, in treating cats naturally infested with fleas and/or ticks. CURRENT RESEARCH IN PARASITOLOGY & VECTOR-BORNE DISEASES 2022; 2:100099. [PMID: 35991085 PMCID: PMC9382417 DOI: 10.1016/j.crpvbd.2022.100099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/23/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Dejan Cvejić
- Klifovet GmbH, Geyerspergerstr. 27, 80689, München, Germany
| | - Klaus Hellmann
- Klifovet GmbH, Geyerspergerstr. 27, 80689, München, Germany
| | - Gabriele Petry
- Bayer Animal Health GmbH an Elanco Animal Health Company, Alfred Nobel Str. 50, 40789, Monheim, Germany
| | - Hannah Ringeisen
- Bayer Animal Health GmbH an Elanco Animal Health Company, Alfred Nobel Str. 50, 40789, Monheim, Germany
| | - Hannah Hamburg
- Bayer Animal Health GmbH an Elanco Animal Health Company, Alfred Nobel Str. 50, 40789, Monheim, Germany
| | - Róbert Farkas
- Department of Parasitology and Zoology, Faculty of Veterinary Medicine, Szent István University, István u. 2, Budapest, 1078, Hungary
| | - Katrin Blazejak
- Vetoquinol S.A., 37 rue de la Victoire, 75009, Paris, France
| | - Norbert Mencke
- Vetoquinol S.A., 37 rue de la Victoire, 75009, Paris, France
- Corresponding author.
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Lavan RP, Armstrong R, Newbury H, Normile D, Hubinois C. Flea and tick treatment satisfaction, preference, and adherence reported by cat owners in the US, UK, or France who treated their cats with transdermal fluralaner. Open Vet J 2021; 11:458-467. [PMID: 34722211 PMCID: PMC8541722 DOI: 10.5455/ovj.2021.v11.i3.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/11/2021] [Indexed: 11/03/2022] Open
Abstract
Background Fluralaner (Bravecto®) is an isoxazoline class compound that is the only topically applied systemic ectoparasiticide approved for dosing at up to 12-week intervals for flea and tick control in cats. Aim To describe veterinarian recommendations for ectoparasiticide medications used in the UK and France along with veterinary recommendations previously reported from the US, as well as to assess cat owners' experience with a commercial transdermal spot-on fluralaner formulation administered to cats in the US and similarly describe the experiences of cat owners from the UK or France who administered fluralaner for feline flea and tick prevention. Methods Clients of participating veterinary practices in the US, UK, or France who were visiting the clinic for a routine wellness visit, were currently treating their cat with fluralaner (Bravecto®), and had purchased at least two doses were asked to complete a short two-page survey about their experience with flea and tick medications including fluralaner and other products they may have been administered. Results Owners in the US (451 cats), UK (512 cats), and France (520 cats) completed surveys. Most cat owners (66%-75%) had previously administered other flea and tick products. More than 94% of cat owners surveyed in each country were satisfied or very satisfied with fluralaner. The most frequently reported benefit of using fluralaner was the 12-week dosing interval, selected by 76% of respondents in the US, 82% in the UK, and 70% in France. 79%-88% of cat owners (depending on the country) thought that dosing with extended duration fluralaner was more convenient than dosing with monthly flea and tick products and 86%-89% of cat owners that had used other flea and tick products preferred fluralaner over the other flea and tick products. Conclusion Veterinarians in the US, UK, and France recommended 12 months of flea protection and 9-11 months of tick protection per year, even though, in this study, cat owners usually purchased 1-3 months of protection per year. A longer flea and tick dosing interval, as seen with fluralaner, correlates with higher user satisfaction and preference among cat owners. Owners identified the 12-week dosing interval and single dose efficacy as the top reasons for selecting the fluralaner product for their cat. In all three countries, most cat owners indicated that they were more likely to deliver doses of extended duration fluralaner on time, compared to flea and tick products dosed monthly.
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Affiliation(s)
- Robert Philip Lavan
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
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Bebrysz M, Wright A, Greaves M, Rathwell Deault D, Hopkins G, Gildea E, Aballéa S. How pet owners choose antiparasitic treatments for their dogs: A discrete choice experiment. Prev Vet Med 2021; 196:105493. [PMID: 34564053 DOI: 10.1016/j.prevetmed.2021.105493] [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: 04/21/2021] [Revised: 09/06/2021] [Accepted: 09/12/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND External and internal parasites can cause significant pathology to pets, posing distress to their owners. Antiparasitic treatment is complex because there are many antiparasitic products and dog owners have a limited understanding of parasiticides. The aim of this study was to investigate the characteristics of antiparasitic treatments available at veterinary offices to help veterinarians understand what pet owners value when selecting parasiticides for their dogs. METHODS Discrete choice experiment (DCE) methodology was used. A list of important treatment attributes was developed based on semi-structured interviews with six dog owners with a total of nine dogs and six veterinarians. The questionnaire including 12 choices between pairs of hypothetical products defined according to treatment attributes was developed. The questionnaire was administered to UK dog owners recruited through an internet panel. It was tested in a pilot study with 17 dog owners, and then was completed by 160 dog owners in the main study. RESULTS The selected treatment attributes were price, spectrum of action, veterinarian recommendation, treatment schedule, mode of administration, and place of obtention. The main analysis showed the first four of these attributes significantly influenced the preferences of dog owners for antiparasitic treatments. The most important factor was spectrum of action; most owners expressed a preference for products treating multiple parasites. The influence of price was comparable to that of spectrum of action. Pet owners were more likely to choose a product recommended by their veterinarian. Willingness-to-pay estimates were £11.22 [€12.68; $15.38] for extending protection from fleas and ticks only to intestinal worm and lungworm and £7.21 [€8.14; $9.87] for recommendation from veterinarian. CONCLUSIONS A broad spectrum of action, veterinarian recommendation, and price are key drivers for choosing antiparasitic products among dog owners. These results may help veterinarians with recommendations of antiparasitic treatment for pet owners based on the key drivers pet owners value.
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Lavan R, Normile D, Husain I, Singh A, Heaney K. Analysis of gaps in feline ectoparasiticide purchases from veterinary clinics in the United States. Parasit Vectors 2021; 14:264. [PMID: 34016157 PMCID: PMC8135142 DOI: 10.1186/s13071-021-04768-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/03/2021] [Indexed: 11/20/2022] Open
Abstract
Background The study objective was to examine cat owner ectoparasiticide purchases in the United States and estimate the impact of purchase gaps on timely ectoparasite protection administration. These purchase gaps lead to periods of time when cats are unprotected from ectoparasites. Methods Ectoparasiticide purchase transactions for individual cats from 671 U.S. veterinary clinics from January 1, 2017 through June 30, 2019 were evaluated to determine time “gaps” between doses of ectoparasiticides purchased in a defined 12-month period. Ectoparasiticides examined were topically applied products that contained fluralaner, fipronil/(S)-methoprene/pyriproxyfen, imidacloprid/pyriproxyfen or selamectin as active ingredients. The duration of protection following administration of one dose was 8–12 weeks for the fluralaner-containing product and one month for the other products. Results Ectoparasiticide purchase records were obtained from 114,853 cat owners and analysis found that most owners bought ≤ 6 months of protection during the year, with 61–75% (depending on the product) purchasing just 1–3 months of protection. The size of the average purchase gap was determined for all dose combinations out to 12 months of protection (5–7 doses for fluralaner and 12 doses for the other three products dosed monthly. The largest gaps occurred between the first and second doses and the second and third doses. Average purchase gaps for the four different products between doses 1 and 2 ranged from 11.2 to 13.9 weeks and between doses 2 and 3 ranged from 7.7 to 12.2 weeks. The fraction of purchases separated by gaps and the average length of the gap tended to decrease with increasing number of doses purchased. Owners purchasing the 8 to 12-week duration product containing fluralaner provided ectoparasite protection (“doses plus gap period”) for a larger proportion of each 2-dose period compared with owners purchasing products administered monthly. Conclusions When cat owners purchase flea and tick medication, gaps between subsequent purchases reduces the proportion of time ectoparasite protection can be provided. The duration of the gap between doses has an impact on the effectiveness of flea/tick medication because it inserts a period without flea and tick protection between doses of flea and tick medication. The gaps between purchases were shorter and the period of ectoparasite protection was larger for owners purchasing a 12-week product than for owners purchasing a monthly product. ![]()
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Affiliation(s)
- Robert Lavan
- Center for Observational and Real-World Evidence, Merck & Co., Inc, Kenilworth, NJ, USA.
| | | | - Imran Husain
- Celeritas Solutions LLC, 157 Columbus Avenue, 4th Floor, New York, NY, USA
| | - Amita Singh
- Zickin School of Business, Baruch College CUNY, 55 Lexington Avenue, New York, NY, USA
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Lavan R, Armstrong R, Normile D, Vaala W. Adherence to veterinary recommendations for ectoparasiticides purchased by cat owners in the USA. Parasit Vectors 2020; 13:541. [PMID: 33129346 PMCID: PMC7602296 DOI: 10.1186/s13071-020-04415-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/21/2020] [Indexed: 12/31/2022] Open
Abstract
Background Safe and effective flea and tick treatment options for cats are important in companion animal practice because of feline ectoparasite infestation prevalence and the potential for parasitic disease transmission. Retrospective cat owner purchasing transactions at United States of America (USA) veterinary clinics were obtained for three topical feline flea and tick ectoparasiticides. One medication, fluralaner, had a 12-week redosing interval, while two other medications (fipronil/s-methoprene/pyriproxyfen; imidacloprid/pyriproxyfen) were approved for monthly redosing. The annual number of doses purchased by cat owners was determined for each of the three medications and then compared between medications. The objective was to evaluate whether 12-week retreatment intervals resulted in a different duration of coverage compared to monthly treatments for ectoparasiticide products. Methods Study results were obtained by analyzing the transactional records from a commercial database derived from veterinary practice management software. The study database consisted of cat owner purchasing records from January 2017 through June 2019 from 671 veterinary practices representing 41,630 cats. Results Cat owners purchased an average of 1.5 doses of fluralaner per year which, based on a 12-week redosing interval, provides 4.2 months of treatment coverage. Cat owners who used monthly flea and tick medications respectively purchased 3.6 months (fipronil/s-methoprene/pyriproxyfen combination) and 2.8 months (imidacloprid/pyriproxyfen) annually of each of the two medications. Average yearly cat owner purchases of fluralaner provide a significantly longer duration of coverage than for cat owners purchasing fipronil/s-methoprene/pyriproxyfen (17% more) or imidacloprid/pyriproxyfen (50% more). Conclusions Cat owners who obtained a flea and tick treatment with a 12-week redosing interval (fluralaner) protected their cats for up to 17% or 50% longer duration each year, respectively, compared to the duration of protection obtained by cat owners who used a medication re-dosed monthly. Cat owners should increase their duration of flea and tick coverage to come closer to achieving veterinary recommendations.![]()
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Affiliation(s)
- Robert Lavan
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA.
| | - Rob Armstrong
- Merck Animal Health, 2 Giralda Farms, Madison, NJ, USA
| | | | - Wendy Vaala
- Merck Animal Health, 2 Giralda Farms, Madison, NJ, USA
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Lavan R, Armstrong R, Lipworth K, Normile D, Newbury H. Flea and tick treatment satisfaction, preference, and adherence of dog owners in the United States, United Kingdom, and Australia who treated their dog with fluralaner. Open Vet J 2020; 10:135-143. [PMID: 32821658 PMCID: PMC7419070 DOI: 10.4314/ovj.v10i2.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 03/24/2020] [Indexed: 11/24/2022] Open
Abstract
Background: An extended duration flea and tick medication of the isoxazoline class (fluralaner) was introduced in 2014 in the United States and other countries. A survey was developed in 2016 to gauge dog owner adherence with veterinary recommendations around the administration of preventive flea and tick medications. Current fluralaner-using dog owners were also asked to compare their experience with opinions on monthly flea and tick products. Aim: To survey dog owners who were current users of fluralaner on their opinions, experiences, and attitudes around the administration of flea and tick medications to their dogs in light of current veterinarian recommendations. Methods: Dog owners in the United States (US), United Kingdom (UK), and Australia that gave fluralaner oral chews to their dogs were asked to compare their experience using fluralaner (12-week dosing) and monthly flea and tick medications. The survey responses of dog owners in the UK and Australia were compared against responses to a similar survey conducted in the US in 2017. Surveys were completed by dog owners who were in the clinic for any reason other than a sickness visit. Additionally, veterinarians that prescribed fluralaner from all three countries provided their annual flea and tick treatment recommendation for dogs. Results: A sample of veterinarians from the US, UK, and Australia that prescribe fluralaner recommend that dog owners obtain approximately 12 months of flea protection per year and 9–12 months of tick protection per year. A variable proportion of owners (22%–90%) reported that their dog participates in outdoor and social activities associated with an increased flea and tick exposure risk. A similarly variable proportion of owners reported prior experience of finding fleas (24%–50%) or ticks (18%–35%) on their dogs. All participating owners treated their dogs currently with fluralaner and most (68%–77%) had previously treated their dog with monthly flea and tick products. The convenience of 12-week dosing and less frequent dosing were the most frequently identified product qualities associated with their choice of an extended effect flea and tick treatment. Conclusion: Most veterinarians surveyed in this survey recommended year-round use of a flea and tick medication for dogs in the US, UK, and Australia. Dog owners recalled the veterinary recommendation for flea and tick prevention as 8–10 months per year. Most dog owners from the clinics in the US, UK, and Australia had used shorter-acting (monthly) flea/tick medications previously. The majority of those who currently gave fluralaner doses to their dogs were “satisfied” or “very satisfied” with the extended duration flea and tick product. Preference for a 12-week duration medication over monthly re-treatment was also high (82%–92%) in all three countries and was associated with convenience.
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Affiliation(s)
- Robert Lavan
- Outcomes Research, Merck Animal Health, Center for Observational and Real-World Evidence, Merck & Co., Inc, Kenilworth, NJ, USA
| | | | | | | | - Hannah Newbury
- MSD Animal Health, Walton Manor, Walton, Milton Keynes, UK
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Briand A, Cochet-Faivre N, Prélaud P, Armstrong R, Hubinois C. Open field study on the efficacy of fluralaner topical solution for long-term control of flea bite allergy dermatitis in client owned cats in Ile-de-France region. BMC Vet Res 2019; 15:337. [PMID: 31604435 PMCID: PMC6788036 DOI: 10.1186/s12917-019-2081-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 09/06/2019] [Indexed: 11/30/2022] Open
Abstract
Background Flea bite is considered to be the main cause of allergic dermatitis in cats. There is a need for treatments able to control clinical signs of allergic dermatitis associated with flea bite in cats. This was an open pre-treatment versus post-treatment clinical field study. All cats included in the study presented pruritus, skin lesions or other evidence compatible with flea infestation. Skin lesions were assessed (using SCORFAD) at days 0, 28, 56 and 84 whereas pruritus severity was assessed (using PVAS) at days 0, 15, 28, 56 and 84. On day 0, The fluralaner (280 mg/ml) product (Bravecto® spot-on for cats) was supplied in pipettes containing 0.4, 0.89 and 1.79 ml for cats of 1.2–2.8 kg, > 2.8–6.25 kg and > 6.25–12.5 kg body weight, respectively. The other animals living in the same household also received fluralaner. Based on cytological examination at day 0, oral amoxicillin and clavulanic acid was prescribed for 21 days if indicated. For cats presenting intense pruritus and discomfort at day 0, oral prednisolone at 0.5 mg/kg was prescribed for 3 days. Results During the study all cats, except for one (cat number 10), improved significantly. Post-treatment median SCORFAD scores at all evaluations were significantly different from the pre-treatment score on day 0 (P values < 0.002 for all three post treatment examination days) with a score reduction of 49% on day 28, 79% on day 56 and 87% on day 84. The PVAS score decreased significantly over the study period for all cats but one (cat number 10). Post-treatment median PVAS scores at all evaluations were significantly different from the pre-treatment PVAS score on day 0 (P value < 0.002 for all four post-treatment days) with a reduction of 46% on day 15, 67% on day 28, 82% on day 56 and 92% on day 84. No adverse reaction or other health issue was reported during the study. Conclusions A single topical treatment with fluralaner results in a significant reduction of flea bite allergic dermatitis clinical signs in cats over the subsequent 12 weeks without any additional environmental treatment.
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Affiliation(s)
- Amaury Briand
- Department of Parasitology, Mycology, Dermatology, EA 7380 UPEC Dynamyc, Ecole nationale vétérinaire d'Alfort, F-94700, Maisons-Alfort, France. .,ADVETIA Veterinary Hospital center, 9 Avenue Louis Breguet, 78140, Vélizy-Villacoublay, France.
| | - Noelle Cochet-Faivre
- Department of Parasitology, Mycology, Dermatology, EA 7380 UPEC Dynamyc, Ecole nationale vétérinaire d'Alfort, F-94700, Maisons-Alfort, France
| | - Pascal Prélaud
- ADVETIA Veterinary Hospital center, 9 Avenue Louis Breguet, 78140, Vélizy-Villacoublay, France
| | - Rob Armstrong
- Merck Animal Health, 2 Giralda Farms, Madison, NJ, USA
| | - Céline Hubinois
- MSD Santé Animale, 7 Rue Olivier de Serres - Angers Technopole CS17144 -49 071, Beaucouze, France
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Lavan R, Armstrong R, Tunceli K, Normile D. Dog owner flea/tick medication purchases in the USA. Parasit Vectors 2018; 11:581. [PMID: 30400923 PMCID: PMC6218982 DOI: 10.1186/s13071-018-3142-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/10/2018] [Indexed: 12/29/2022] Open
Abstract
Background Veterinary clinic transaction records from the USA were examined to determine dog owner purchase patterns for three prescription ectoparasiticides. In-clinic purchases of formulations of fluralaner (with 12-week duration per dose) were compared with dog owner purchases of afoxolaner and spinosad (both with 4 week duration per dose) in a population of 231,565 dogs over a 12 month period. Prior studies in human and animal medicine have suggested that patients more closely adhere to prescriber dosing recommendations when they receive a longer-duration medication. Results Veterinary clinic transaction records were examined for the period June 2014 through March 2017 using records from approximately 650 veterinary clinics. Ectoparasiticide purchase patterns were compared for two products (afoxalaner and spinosad) with monthly dosing and one product (fluralaner) with an extended (12 week) dosing interval. The average dog owner who obtained fluralaner purchased significantly more months of flea/tick protection (5.7 months) over the 12-month study period than the average dog owner that selected either afoxolaner (4.6 months) or spinosad (3.3 months). The proportion of dog owners who obtained only one dose of ectoparasiticide per 12-month period was 42% for fluralaner, 30% for afoxolaner and 37% for spinosad. The proportion of dog owners who obtained 2 doses or less per 12-month period was 67% for fluralaner, 52% for afoxoalaner and 67% for spinosad. Owners that obtained fluralaner were significantly more likely to obtain 7.0–12.0 months of flea and tick protection and significantly less likely to purchase 1.0–6.9 months compared with dog owners who purchased afoxolaner or spinosad. Conclusions Dog owners who obtained a flea and tick medication with a longer duration of action acquired significantly more months of protection in a year than dog owners who obtained shorter duration (1 month) products. Dog owners were better able to adhere to veterinary recommendations on ectoparasites control with a longer-acting flea/tick medication.
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Affiliation(s)
- Robert Lavan
- Outcomes Research, Animal Health, Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA.
| | - Rob Armstrong
- Merck Animal Health, 2 Giralda Farms, Madison, NJ, 07940, USA
| | - Kaan Tunceli
- Outcomes Research, Animal Health, Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Dorothy Normile
- Merck Animal Health, 2 Giralda Farms, Madison, NJ, 07940, USA
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