In need of advise for alternative treatment for IMPA

[Whipaway]

HI all,
I am new to this forum & hoping I may get some useful advise.
We have a whippet in the family who was diagnosed with IMPA about 18 months ago.
She has been on steroids & Azathioprine for such a long time & never really had a time in remission.
I have been reading about cyclosporine & that some owners have found this a successful alternative treatment.

I would be most grateful of any advise.

thanks in advance

[Catherine]

Has your dog been on the correct dose and had the medication reduced gradually? See below for a medication protocol.

Cyclosporine has mixed reviews, some dogs it helps, others it can have bad side effects on. If you use the search facility on the main page it will come up with several posts that may help you. Also see here:
http://cimda.co.uk/smf/index.php?topic=15.0


Immunosuppressive Protocols for Oral Prednisolone in the Dog.
Ref: Clinical Immunology of the Dog & Cat by Michael J Day  – Professor of Veterinary Pathology, University of Bristol, UK and WSAVA - Chairman of Scientific Advisory Committee.

This example is based on a dog receiving an induction dose of 1.0mg/kg/q12hrs (every 12 hours).

Dose                Duration (based on clinical effect)

1.0mg/kg/q12h             10-28 days
0.75mg/kg/q12h            10-28 days
0.5mg/kg/q12h             10-28 days
0.25mg/kg/q12h          10-28 days
0.25mg/kg/q24h          10-28 days
0.25-0.5mg/kg/ Every other day      at least 21 days
0.25-0.5 mg/kg/ Every third day       at least 21 days

Azathioprine (a cytotoxic drug) can be used in combination with prednisolone at 2mg/kg/24 or 48 hrs and dose gradually reduced, when remission is achieved, over a period of months.
Clinical response to Azathioprine may take up to 6 weeks. (Plumb's Veterinary Drug Handbook)

Don't forget the gastroprotectant!

[Whipaway]

Hi & thanks
Yes we are aware of the protocol and have stuck to it but never really got to a low dosage before relapsing.
Hence why after all this time it maybe worthy of trying alternative treatment should there be any.

Any advise or shared experience is appreciated.

Thanks

[Jo CIMDA]

Hi
this is an excellent website and it lists most of the other immunosuppressive drugs available.  The use of Mycophenolate is becoming increasingly popular and the the duration of action is relatively quick.  It is worth looking at several alternatives. One often used for IMPA is Leflunomide.

Although IMPA carries a good prognosis, and most dogs can achieve remission and some never get it again, there are a few dogs that have to be maintained on a low dose of pred etc.  Anecdotally, dogs that get IMPA at a young age commonly relapse for a period of a few years then all of a sudden weaning off drugs is successful and they achieve remission.  As far as I know the same is true of human children who get IMPA, so I presume it has something to do with changes in the young body.

I hope you can find a good combination drug to use alongside pred, or to replace the current regimen. 

Jo

[Whipaway]

Many thanks for this information.
very much appreciated.