Immunosuppressive treatment regime Prednisolone by Prof. Michael J Day

[Jo CIMDA]

Immunosuppressive Protocols for Oral Prednisolone in the Dog.
Ref: Clinical Immunology of the Dog & Cat by Michael J Day

Professor Michael DayBSc, BVMS(Hons), PhD, DSc, DiplECVP, FASM, FRCPath, FRCVS 

Professor of Veterinary Pathology, University of Bristol, UK and WSAVA - Chairman of Scientific Advisory Committee.

This example is base on a dog receiving an induction dose of 1.0mg/kg/q12hrs

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!

[gemini]

Hi,

Gem is still on 125 mg twice per day of Atopica and weighs 25 kg.  we are gradually reducing the pred and she is on half a tablet once per day, then reducing to half a tablet every other day after 10 days.  Can't remember the mg dose on the pred but I'm sure you know what I mean!

Any advice on the current dose of Atopica and when we could reduce?

Many thanks,
Emma

[Jo CIMDA]

Hi Emma

I can't remember what AI disease Gem has and why she was put on Atopica.  Dogs with SLE very often have to remain on a maintenance dose of preds and somethines other drugs to stay in remission, but with many other diseases remission can be achieved and maintained without drugs.

It is good that Gem's pred  is being weaned down slowly but if she were mine I would keep my dog on a low every other day dose of pred for life rather than use Atopica as a long term maintenance drug.  I'm sure your vet is intending to lower the dose of Atopica, and again if she were mine I would rather start to lower the dose now, whilst she was on pred, than leave it until she is pred free.   

Atopica (cyclosporin) is licensed for the treatment of skin diseases only, but because it inhibits the T-cells it can also act as an immunosuppressant and in recent years is often used in the 'combination treatment' of other immune mediated disease, however the jury is still out as to whether it actually increases the chances of survival in dogs with, for example, AIHA, IMTP etc.......  Azathioprine was always the 'combination drug of choice' prior to Atopica being licensed but since its license Atopica is being used more and more and I'm not sure the science is there to justify this.

Cyclosporin is sometimes used in combination with preds when the dog hasn't responded to treatment and then the vet may '......consider discontinuing using cyclosporin when remission has been maintained for two weeks.' (Miller 2000, Plumb's veterinary drug handbook).

The only other information I can give to you is the recommended regime in the book Manual of skin diseases of the Dog and Cat by Sue Peterson.

'Cyclosporin:  5.0mg/kg/24hrs   Initial dose given for 4-6 weeks then tapered to lowest possible maintenance dose; should only be given to fit animals and should be regularly monitored by routine blood samples and where appropriate urine analysis.'

This paper (see link below)  is interesting because it proves that  Vitamin E, if used concurrently with cyclosporin (Atopica)  can significantly reduce the amount of cyclosporin used because Vit E enhances the effect of this drug. therefore the dose of drug can be reduced and this makes treatment less expensive. he same can be said for grapefruit juice and some other conventiional drugs eg. ketaconazole. 

http://www.vet.k-state.edu/depts/ap/PDF/fischer.pdf

I haven't used it myself so I can't give any personal experience and I have tried to find a reducing protocol for you ,but in all the books I have and the on-line searches, I haven't come up with anything specific for non skin immune mediated disease. Sorry. 

The skin disease regime in BSAVA Small Animal Formulary states  '5mg/kg/12-24 hrs until signs controlled, then every 48 hrs as a maintenance dose'

Can anyone else help?

Jo