Adherence to veterinary recommendations for ectoparasiticides purchased by cat owners in the USA

Plasma pharmacokinetics of tigolaner, emodepside, and praziquantel following topical administration of a combination product (Felpreva®) and of intravenous administration of the individual active ingredients in cats

Felpreva® for cats contains the new acaricidal/insecticidal active ingredient tigolaner in a fixed combination with the nematocidal and cestocidal compounds emodepside and praziquantel, respectively. The plasma pharmacokinetics of tigolaner, emodepside, and praziquantel were evaluated in clinically healthy cats following topical (spot-on) treatment as fixed combination Felpreva®. For the determination of bioavailability intravenous administration of single active ingredients was also performed. After a single topical administration of Felpreva® using the target dose volume of 0.148 ​ml/kg to cats, tigolaner reached mean peak concentrations of 1352 ​μg/l with a T_max of 12 days and a mean half-life of 24 days. Simulation of repetitive topical administration every 91 days indicates only a low risk of accumulation after reaching steady state within two to three administrations. The volume of distribution calculated after intravenous dosing was 4 ​l/kg and plasma clearance was low with 0.005 ​l/h/kg. Overall plasma exposure was 1566 ​mg∗h/l after topical administration, providing an absolute bioavailability of 57%. Tigolaner was mainly cleared via the faeces (54% within 28 days), renal clearance was neglectable (< 0.5% within 28 days). Emodepside and praziquantel showed mean peak concentrations of 44 ​μg/l and 48 ​μg/l (reached after 1.5 days and 5 ​h, respectively). Overall plasma exposures were 20.6 and 3.69 ​mg∗h/l, respectively. The elimination half-life was 14.5 days for emodepside and 10 days for praziquantel after topical administration. After topical administration of Felpreva® using 2.5× and 5× dose multiples an almost proportional increase of plasma exposure was observed for all three active ingredients. With the addition of tigolaner, Felpreva® combines the established pharmacokinetic (PK) characteristics of emodepside and praziquantel contained in Profender® spot-on for cats with the favourable PK of tigolaner suitable for a 3-months protection against fleas and ticks.

Immediate and long-term efficacy of Felpreva®, a new spot-on formulation containing tigolaner, emodepside and praziquantel, applied as a single application to cats artificially infested with the cat flea Ctenocephalides felis

Five studies (two dose determination, two dose confirmation, and one speed of flea kill study) were conducted to assess the immediate (therapeutic) efficacy and long-term persistent (preventive) efficacy of a single spot-on application containing the novel acaricide and insecticide tigolaner in combination with emodepside and praziquantel (Felpreva®, Vetoquinol S.A. Lure, France) applied to cats artificially infested with Ctenocephalides felis. Eight cats per group were randomly allocated to 0, 1×, 1.3× and 2× of the minimum dose (14.5 ​mg/kg body weight) of tigolaner (dose determination studies) or randomly allocated to 0 and 1× of the dosage (dose confirmation studies). Onset of efficacy was assessed in a speed of flea kill study on an existing flea infestation 8, 12 and 24 ​h after treatment and reassessed after monthly flea reinfestation until 13 weeks post-treatment. Efficacy was calculated according to the Abbott formula using arithmetic means. Efficacy was claimed when (i) control groups were adequately infested (flea retention ≥ 50%) at each time-point in the studies; (ii) flea counts in treated groups were significantly lower (P ​≤ ​0.05) than flea counts in control groups; and (iii) calculated efficacy was ≥ 90% (speed of flea kill study) and ≥ 95% (dose determination and dose confirmation studies). Tigolaner at 14.5 ​mg/kg body weight was 100% effective against fleas on Day 1 (immediate, therapeutic efficacy) in both, dose determination and dose confirmation studies. The long-term persistent efficacy in week 13 ranged between 96.3% and 100%. Fleas were rapidly killed within 12 ​h after treatment (100% flea reduction, immediate efficacy). New flea infestations were successfully prevented for 8 weeks (98.9-100% flea reduction) within 8 ​h after reinfestation, and at week 13 (96.3% flea reduction) within 24 ​h after reinfestation.

Optimizing antimicrobial use by improving medication adherence among pig producers

In Japan, many pig producers buy antimicrobials using veterinarians' prescriptions. Even if veterinarians prescribe antimicrobials for treatments and metaphylaxis, producers may be using them for prophylaxis on farms with a high incidence of chronic diseases. To reduce the frequency of antimicrobial use, we applied the concept of medication adherence and launched an intervention in eight farrow-to-finish farms. For the intervention farms, we attempted to implement measures for preventing the repeated onset of chronic infections that interfered with adherence, confirmed the need to continue medications, and discontinued medications if possible. For each farm, these interventions began at different time points after 2017 and continued until 2020. We evaluated the effectiveness of this intervention based on the amount of active ingredients/population correction unit and the total number of defined daily doses for the weight group/slaughter pig. The ratio of antimicrobial use for both indicators in the year 2020 compared with the start of the intervention decreased on all farms. Among the eight non-intervention farms, six showed an increase in both indicators. These results suggest that interventions for chronic diseases administered by producers and veterinarians lead to high adherence to prescriptions and responsible and prudent use of antimicrobials on pig farms.

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

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.

Analysis of gaps in feline ectoparasiticide purchases from veterinary clinics in the United States

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.