Advice please

[Kate H]

Hi folks. I started a topic here last October regarding my now 3 year old dobermans diagnosis with AIHA. While we had a few hiccups mainly a broken tooth which lead to an abscess and extraction, her bloods have remained good. We are reducing the steroids at a snails pace,mainly for my sanity and currently she is on 5mg of predisilone every second day. Her PCV level last Thursday was 52% which I am thrilled with. She is a 44 kg dobie rottie cross we think as she was a rescue dog. Anyway the vets now think it is a good time to begin to start her on aziathipprine at 12.5mg alternating with the pred. Which is for example pred today, the other one in 2 days time instead of pred and continuing on that cycle with bloods 14 days after we begin.
The vets have said that the aziathioprine is less toxic on her system and is less harmful than the steroid. Could I ask for your opinions please? I am so fearful of causing a relapse and would like to make an informed decision.
Thanks:-)

[polly]

It is good news that your 44kg dog is stable on such a comparatively low dose so if your vet wants to wean your dog off pred  I would  give it a try provided  there are regular check-ups.   

[Jo CIMDA]

Hi Kate

Well done for getting your girl this far.  That's great news.

Personally, I don't see the sense in introducing Azathioprine at this stage.  Why?

Azathioprine is usually introduced at the start of treatment (to give added immunosuppression, which possibly allows the preds to be weaned down quicker, and minimises the severe side effects of the preds and still maintaining some level of immunosuppression).  Or Azathioprine is added as a combination drug if the dog relapses (perhaps during the weaning down process) and has to go back onto a high dose of steroids.  This again is to minimise the side effects of being on high doses of preds for prolonged periods. 

Your girl is clearly in remission and on a very low, every other day dose. You have reduced it very slowly and she must have coped with the side effects - which by now I assume are minimal.    Every other day, very low dose won't have much long term effect, and whose to say you can't successfully wean her off anyway.  It is always worth a try.  The long term problems arise when the dog has to be maintained on a higher dose which is often given every day.

Azathioprine is a great drug but it is cytotoxic, meaning it has the ability to change good cells as well as bad, and although it does not have the same side effects as prednisolone it certainly can and does have side effects or long term effects (there is no free lunch!) and in a way is more toxic than prednisolone.   Azathioprine and Cyclosporin (Atopica) are a Godsend when a dog  (or human) need their immune system to be suppressed but why use it when you don't need to?  These are hard drugs, and even the owner mustn't handle them.

If your dog relapses, which can always happen even on a maintenance dose of preds and/or Azathioprine, and she has to go back onto an immunosuppressive dose of prednisolone then I would add Azathioprine because it will make the weaning down process much easier, especially as she already has had a prolonged course of prednisolone.

One thing you can consider is to reduce the 5mg EOD even further eg. give 2.5mg EOD,  or you can give 5mg every third day for a month or two and then go to every 4th day etc.............  When the dog is on a low dose of preds the regime options are numerous and can be tailored to fit the individual dog.

Jo

[Kate H]

Thanks Jo. I am of a similiar opinion that her current dose is very small and is working well. I am happy to drop it to every 3rd day possibly next month. The vets seem to feel that the steroid is more harmful than the other drug and therefore we should be aiming to replace the pred. I think a chat is in order.

[Jo CIMDA]

Hi Kate

To put the dose of prednisolone in perspective, a replacement hormone dose (when the body is unable to produce it's own cortisol) is 0.2-.0.3mg prednisolone every day.  For a dog of 44kg the minimum dose would be 8.8mg a day.  You are giving her at the moment 5mg every other day so even if you stayed on this dose it is so low the side effects would be very, very  small and probably not noticeable.  Also it takes 4-6+weeks for Azathioprine to have full effect so testing after 14 days wouldn't really tell you anything.

Good luck with your vet
Jo