Ciclosporin A therapy is associated with disturbances in glucose metabolism in dogs with atopic dermatitis

Abstract

The effect of ciclosporin A (CsA) on glucose homeostasis was investigated in 16 dogs with atopic dermatitis by determining plasma glucose, serum fructosamine and insulin concentrations, and serial insulin and glucose concentrations following a glucagon stimulation test, before and 6 weeks after CsA therapy at 5 mg/kg once daily. All dogs completed the study. Following CsA treatment, the median serum fructosamine concentrations were significantly higher (pretreatment 227.5 μmol/L; post-treatment 246.5 μmol/L; P = 0.001; reference range 162-310 μmol/L). Based on analyses of the areas under concentration-time curves (AUC) pre- and post-CsA treatment, plasma glucose concentrations were significantly higher (AUC without baseline correction 31.0 mmol/L/min greater; P = 0.021) and serum insulin concentrations were significantly lower (AUC without baseline correction 217.1 μIU/mL/min lower; P = 0.044) following CsA treatment. Peak glucose concentrations after glucagon stimulation test were significantly higher following CsA treatment (10.75 versus 12.05 mmol/L; P = 0.021), but there was no significant difference in peak serum insulin (52.0 versus 35.0 μIU/mL; P = 0.052). There was a negative correlation between baseline uncorrected insulin AUC and trough serum log CsA concentrations (r = -0.70, P = 0.005). The administration of CsA to dogs with atopic dermatitis leads to disturbances in glucose homeostasis. The clinical significance of this is unclear, but it should be taken into account when considering CsA treatment in dogs that already have such impairments.

Prednisolone therapy for atopic dermatitis is less effective in dogs with lower pretreatment serum 25‐hydroxyvitamin D concentrations

“…All of these dogs had no history of previous skin disease, were considered healthy by their owners and were normal on physical examination. In order to examine whether serum 25(OH)D concentrations were predictive of clinical response to a range of medications, we also measured serum 25(OH)D concentrations in a previously published cohort of atopic dogs that were treated with CsA 30 . This cohort of dogs was recruited in a similar time frame to the prednisolone‐treated dogs, and all samples were handled in the same way.…”

“…In order to examine whether serum 25(OH)D concentrations were predictive of clinical response to a range of medications, we also measured serum 25(OH)D concentrations in a previously published cohort of atopic dogs that were treated with CsA. 30 This cohort of dogs was recruited in a similar time frame to the prednisolone-treated dogs, and all samples were handled in the same way. The response to CsA therapy was evaluated by the same person as the prednisolonetreated dogs (M.K.).…”

Reference Point: Exploring fructosamine beyond diabetes mellitus

“…Blood glucose concentrations were as high as 28 mmol/L (505 mg/dL), yet the correlation between blood glucose and fructosamine measurements was poor (r = 0.14). 82 A study 83 performed by the same authors failed to find significant differences using anti-inflammatory dosages of prednisolone in healthy dogs, despite 11 of 16 dogs having posttreatment hyperfructosaminemia. 69 A study 33 investigating the effect of duration and magnitude of experimentally induced hyperglycemia on fructosamine concentrations in healthy cats demonstrated significant differences in fructosamine dynamics between moderate and marked hyperglycemia.…”

A prospective study of basal insulin concentrations in dogs with congenital portosystemic shunts

“…Serum insulin concentrations were measured using a commercial one‐step solid‐phase immunoradiometric assay which is validated for use in dogs (Immunotech, Marseille; reference interval: 4·4 to 17·6 μU/L; assay detection limit: 2 μU/L) at Cambridge Specialist Laboratory Services. The use of this reference range was previously reported (Watson and Herrtage 2004, Gow and others 2011, Kovalik and others 2011).…”