Ciclosporin oral solution in cats: a retrospective survey of compliance with treatment and adverse effects

OBJECTIVES

The aim of the study was to assess long-term ciclosporin oral solution compliance in cats treated for feline atopic skin syndrome (FASS).

METHODS

A survey was sent by email to 114 owners who had administered ciclosporin oral solution to their cats for FASS.

RESULTS

In total, 42 owners completed the survey. The population was composed of 30 domestic shorthair cats and 12 pure breeds. There were 20 males and 22 females, and the median age was 5.5 years. Ciclosporin oral solution was administered directly into the mouth in 32/42 (76%) and with food/other in 10/42 (24%) cats. The administration was considered easy in 18/42 (43%) cats, difficult in 23/42 (55%) and impossible in 1/42 (2%). Treatment was stopped in 25/42 (60%) cats. The causes were as follows: administration difficulty (nine cats, 21%); complete resolution (four cats, 10%); treatment failure (four cats, 10%); price (two cats, 4%); and other causes (two deaths, two neoplasia, one adverse effect and one lack of compliance). Adverse effects involving clinical signs were reported in 25 (60%) cats: ptyalism (8/42); dysorexia/anorexia (6/42); vomiting (4/42); diarrhoea (4/42); gingival hyperplasia (1/42); and a combination of vomiting, diarrhoea and ptyalism (2/42). In addition, altered behaviour was reported in 27/42 (64%) cats: hiding in seven cats; scared of owner in 10 cats; modification of sleeping or playing activity in six cats; inappropriate urination/defecation in two cats; aggression in one cat; and all of the above in one cat.

CONCLUSIONS AND RELEVANCE

In total, 24 (57%) cats had adverse effects involving both clinical signs and altered behaviour, and only six cats had either adverse clinical signs or behavioural changes. This survey showed that behavioural changes appear to be underestimated in the cats treated with ciclosporin oral solution and this could cause treatment failure due to lack of compliance. Larger-scale studies are needed to confirm these preliminary results.

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

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.

The novel high molecular weight Dermatophagoides farinae protein Zen-1 is a major allergen in North American and European mite allergic dogs with atopic dermatitis

BACKGROUND

Atopic dogs with hypersensitivity to Dermatophagoides farinae (Df) have IgE recognizing high molecular weight (MW) allergens more often than the low MW Der f 1 and 2. A new high MW Df allergen, Zen-1, has been identified recently.

OBJECTIVES

To determine the IgE reactivity of American and European Df-hypersensitive dogs to Zen-1, Der f 1 and Der f 2.

METHODS

We tested sera from 33 Df-reactive dogs from the USA, 29 from Europe and 15 experimentally sensitized to Df, by ELISA against crude Df, Der f 1, Der f 2 and Zen-1. ELISA inhibition was performed with sera reactive to Zen-1. Intradermal testing (IDT) was also done with the same allergens in 25 other American atopic dogs.

RESULTS

Altogether, IgE seropositivity to Zen-1 was more prevalent (86%) than that to Der f 1 (17%) or Der f 2 (19%). The IgE reactivity to Zen-1 was correlated to that against crude Df; this allergen alone inhibited a high percentage (median: 50%; range: 22-84%) of the binding to the crude mite extract. The seropositivity to low MW allergens was highest in experimentally sensitized dogs. Serum IgE recognition of Der f 1 was low in dogs with AD; that to Der f 2 was significantly lower in American dogs (6%) than in European ones (28%). A high prevalence of positive immediate IDT reactions to Zen-1 confirmed the likely relevance of serological results.

CONCLUSIONS AND CLINICAL IMPORTANCE

This study establishes Zen-1 as a major allergen in atopic dogs sensitized to Df.

Critically appraised topic on adverse food reactions of companion animals (2): common food allergen sources in dogs and cats

BACKGROUND

To diagnose cutaneous adverse food reactions (CAFRs) in dogs and cats, dietary restriction-provocation trials are performed. Knowing the most common offending food allergens for these species would help determining the order of food challenges to optimize the time to diagnosis.

RESULTS

The search for, and review and analysis of the best evidence available as of January 16, 2015 suggests that the most likely food allergens contributing to canine CAFRs are beef, dairy products, chicken, and wheat. The most common food allergens in cats are beef, fish and chicken.

CONCLUSIONS

In dogs and cats, after a period of dietary restriction leading to the complete remission of clinical signs, food challenges to diagnose CAFR should begin with beef and dairy products, the most commonly recognized food allergens in these two species.

Critically appraised topic on adverse food reactions of companion animals (1): duration of elimination diets

BACKGROUND

Restrictive (i.e. elimination)-provocation dietary trials remain the standard of care to diagnose cutaneous adverse food reactions (CAFRs) in dogs and cats. There is currently no consensus on the duration of elimination diet trials that would permit the highest sensitivity of diagnosis of CAFR in companion animals.

RESULTS

The search for, and review and analysis of the best evidence available as of December 14, 2014 suggests that, by 5 weeks in dogs and 6 weeks in cats after starting an elimination diet, more than 80 % of patients had achieved a remission of clinical signs of CAFR. Increasing the diet trial duration to 8 weeks leads to a complete remission in more than 90 % of dogs and cats with CAFR.

CONCLUSIONS

For diagnosing CAFRs in more than 90 % of dogs and cats, elimination diet trials should last at least 8 weeks.

Treatment of canine atopic dermatitis: 2015 updated guidelines from the International Committee on Allergic Diseases of Animals (ICADA)

Background

In 2010, the International Task Force on Canine Atopic Dermatitis (now International Committee on Allergic Diseases of Animals, ICADA) published the first consensus guidelines for the treatment of atopic dermatitis (AD) in dogs. This is the first 5-year minor update of this document.

Results

The treatment of acute flares of AD should involve the search for, and then elimination of, the cause of the flares, bathing with mild shampoos, and controlling pruritus and skin lesions with interventions that include topical and/or oral glucocorticoids or oclacitinib. For chronic canine AD, the first steps in management are the identification and avoidance of flare factors, as well as ensuring that there is adequate skin and coat hygiene and care; this might include more frequent bathing and possibly increasing essential fatty acid intake. The medications currently most effective in reducing chronic pruritus and skin lesions are topical and oral glucocorticoids, oral ciclosporin, oral oclacitinib, and, where available, injectable recombinant interferons. Allergen-specific immunotherapy and proactive intermittent topical glucocorticoid applications are the only interventions likely to prevent or delay the recurrence of flares of AD.

Conclusions

This first 5-year minor update of the international consensus guidelines for treatment of AD in dogs further establishes that the treatment of this disease is multifaceted, and that interventions should be combined for a proven (or likely) optimal benefit. Importantly, treatment plans are likely to vary between dogs and, for the same dog, between times when the disease is at different stages.

Electronic supplementary material

The online version of this article (doi:10.1186/s12917-015-0514-6) contains supplementary material, which is available to authorized users.

Dose tapering for ciclosporin in cats with nonflea-induced hypersensitivity dermatitis

BACKGROUND

Little information is available on the ciclosporin dose-tapering regimen and clinical response in the treatment of feline hypersensitivity dermatitis.

HYPOTHESIS/OBJECTIVES

To test a dose-tapering regimen and assess efficacy and clinical safety for up to 18 weeks.

ANIMALS

Eighty-eight client-owned cats with feline hypersensitivity dermatitis.

METHODS

Cats that received either a placebo or ciclosporin at 2.5 mg/kg or 7 mg/kg daily for 6 weeks were given 7 mg/kg ciclosporin daily for 4 weeks. Depending on the clinical response, the dose was tapered from daily to every other day over the next 4 weeks and further to twice a week for an additional 4 weeks.

RESULTS

After all cats received 7 mg/kg for 4 weeks, the dose could be tapered to every other day for the next 4 weeks in 70% of cats remaining in the study. During the next 4 weeks, 57, 15 and 22% of cats remaining in the study could be treated at twice a week, every other day or daily, respectively. After the first 4 weeks, the mean lesion score and owner-assessed pruritus improved over baseline by 69 and 61%, respectively, and remained stable during the following 8 weeks. Approximately 65% of the cats in the study were reported to have an adverse event (AE), very often mild and resolving spontaneously. The most frequent AEs were gastrointestinal and included primarily vomiting and diarrhoea. Eighty per cent of AEs occurred when cats were on daily treatment.

CONCLUSIONS AND CLINICAL IMPORTANCE

Results suggest that the induction dose of 7 mg/kg ciclosporin can be tapered as soon as 4 weeks without deterioration of the clinical response. Establishment of the lowest effective dosing regimen of ciclosporin reduced the frequency of AEs.

Prospective study of bacterial overgrowth syndrome in eight dogs

Eight dogs with cutaneous lesions, clinical signs and cytological findings compatible with bacterial overgrowth syndrome were compared with four healthy dogs. The affected dogs were treated for 28 days with 30 mg/kg/day cephalexin. The results showed that the syndrome was a superficial cutaneous disorder characterised by marked pruritus, greasy seborrhoea, offensive odour, erythema, lichenification, hyperpigmentation, excoriations and alopecia involving principally the ventral aspect of the body, but no papules, pustules, epidermal collarettes or crusts; it was caused by overgrowths of Staphylococcus intermedius all over the body surface. Histopathological findings included a superficial, perivascular, hyperplastic and spongiotic dermatitis with a mixed inflammatory infiltrate, but no lesions suggestive of a true pyoderma. In the affected dogs, anti-staphylococcal immunoglobulin G levels were high, but anti-staphylococcal immunoglobulin E levels were low, suggesting that staphylococcal hypersensitivity is not the underlying pathogenic process. The antibiotic treatment improved the condition of all the dogs, but five of the eight had an underlying allergic skin disease.

Cutaneous manifestations of neurological diseases: review of neuro-pathophysiology and diseases causing pruritus

Pruritus does not always originate from stimulation to the skin associated with primary dermatological disorders. It may be caused by neurological or behavioural disorders. The essential role of the nervous system in the control (enhancement and inhibition) of pruritus and its pathophysiology are presented. In order to allow differentiation between dermatological and neurological disorders, inherited or acquired peripheral neuropathies and central nervous disorders (Arnold-Chiari syndrome, seizure-related disorders, central nervous system tumours) that may induce itch are discussed.

Randomized controlled trial of the efficacy of cyclosporine in the treatment of atopic dermatitis in dogs

OBJECTIVE

To evaluate efficacy of cyclosporine A, administered at either of 2 dosages, in dogs with atopic dermatitis (AD).

DESIGN

Multicenter randomized controlled trial.

ANIMALS

91 dogs with AD.

PROCEDURE

Dogs were assigned to receive placebo (30 dogs), cyclosporine at a low dosage (2.5 mg/kg [1.1 mg/lb], PO, q 24 h for 6 weeks; 30 dogs), or cyclosporine at a high dosage (5.0 mg/kg [2.3 mg/lb], PO, q 24 h for 6 weeks; 31 dogs).

RESULTS

After 6 weeks, mean percentage reductions, compared with baseline scores, in scores of lesion severity were 34, 41, and 67% for dogs treated with the placebo, cyclosporine at the low dosage, and cyclosporine at the high dosage, respectively. Similarly, mean percentage reductions in pruritus scores were 15, 31, and 45%, respectively. Percentage reductions in skin lesion and pruritus scores were significantly higher for dogs given cyclosporine at the high dosage than for dogs given the placebo. Treatment efficacy was significantly associated with whether dogs had a history of seasonal AD. Percentage reductions in skin lesion and pruritus scores were high for dogs treated with cyclosporine at the highest dosage that had a history of nonseasonal AD. Dogs in all groups with seasonal AD improved during the study period.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that oral administration of cyclosporine at a dosage of 5.0 mg/kg once daily is effective in reducing severity of pruritus and skin lesions in dogs with AD, especially those with nonseasonal disease.

The I protein of the heterogeneous nuclear ribonucleoprotein complex is a novel dog nuclear autoantigen

In eukaryotic cells, heterogeneous nuclear RNA is associated with a set of abundant nuclear proteins to form complex ribonucleoprotein structures (hnRNP). Autoantibodies to hnRNP G protein have been previously reported in German shepherd dogs with lupus-like syndrome. In the present study, we describe the characterization of a novel antigen recognized by a serum from a schnauzer dog with a non-erosive polyarthritis. The autoantibodies give, by indirect immunofluorescence, a nuclear pattern with staining close to one of the nucleoli. Immunoblotting and immunoprecipitation data reveal that the autoantigens are in fact two closely related basic proteins (average pI 8.7) with apparent molecular weights of 56 kDa (p56) and 59 kDa (p59). The results of immunoprecipitation with anti-hnRNP antibodies and DNA affinity column chromatography strongly suggest that these autoantigens correspond to hnRNP I proteins. This point was confirmed by cloning and sequencing a cDNA clone encoding the complete sequence of the antigens. In addition, we found that anti-hnRNP I antibodies preferentially stain certain loops of the Pleurodeles waltl lampbruch chromosomes. These data, added to previous ones on anti-p43/hnRNP G protein in German shepherd dogs with lupus-like syndrome, confirm the interest of this category of antibodies to hnRNP proteins in autoimmune disorders.

Allergic contact dermatitis in the dog. Principles and diagnosis

Allergic contact dermatitis is a rare hypersensitivity disorder in the dog. Clinical diagnosis is not easy. Primary lesions are transient. Secondary lesions caused by chronic inflammation and self-trauma are commonly present on typical areas, especially in sparsely haired regions and on the feet. A presumptive diagnosis can be made based on the history, clinical signs, and positive standardized closed patch testing. Histopathology and basophil degranulation testing may also be helpful in supporting the diagnosis and in identifying the offending allergens. However, a definitive diagnosis can be made only after restriction-provocation testing. With better understanding of the pathogenesis and clinical signs, and with increased availability of diagnostic tests (especially a standardized closed patch test), increased recognition of this dermatosis is expected.