Cyclosporin as the sole treatment for anal furunculosis: preliminary results

Abstract

Cyclosporin was used, as the sole agent, to treat six cases of anal furunculosis, allowing the clinical response to the drug to be evaluated. The initial dose was 7.5 mg/kg twice a day. Following one week of treatment, whole blood cyclosporin trough levels were measured and the dose was adjusted to obtain a stable trough level of 400 to 600 ng/ml. In all dogs, the lesions were found to follow a similar pattern of resolution throughout the course of treatment. The presenting signs disappeared within one week of treatment, with a reduction in lesion size of 50 to 90 per cent. Lesions then gradually healed over the remainder of the treatment, which lasted from 10 to 20 weeks. One case required cryosurgical treatment to resolve a 2 mm diameter persistent ulcerated lesion following 18 weeks of treatment. The length of follow-up was four to 14 months (mean 7.7 months). One case developed recurrence of the lesions eight weeks post-treatment.

The role of surgery in the management of canine anal furunculosis. A review of the literature and a retrospective evaluation of treatment by surgical resection in 51 dogs

“…Alternatively, AF may be the result of T-cell dysfunction (Killingsworth 1988b;Day 1993 lies in the response of AF to T-cell-directed medications such as cyclosporine and in results of recent cytokine assays Griffi ths et al 1999;Mouatt 2002;Patricelli et al 2002;Doust et al 2003;House et al 2003;O'Neill et al 2004;Hardie et al 2005). The possibility also exists that AF is a result of professional antigen-presenting cell dysfunction with subsequent dysregulation of T-and B-effectorcell function.…”

“…Although the exact molecular mechanisms of its initiation have not been fully elucidated, many recent studies have described the positive response of AF to immunosuppressive therapies such as prednisolone, cyclosporine and azathioprine, making an immune-mediated cause highly probable (Harkin et al 1996;Griffi ths et al 1999;Tisdall et al 1999;Misseghers et al 2000;Mouatt 2002;Patricelli et al 2002;Doust et al 2003;Robson and Burton 2003;O'Neill et al 2004;Hardie et al 2005). For this reason, conservative treatment strategies for the medical management of AF, such as systemic and/or topical antibiotics, topical antiseptics, hair clipping, faecal softeners, hydrotherapy and dietary modifi cation (e.g.…”

“…Furthermore, the optimum dose rates, dose intervals and duration of treatments are still debated, and a wide range of dosages has been cited, e.g. 1.5-15 mg/kg PO every 12-24 h for 2-24 weeks Woolridge et al 1998;Griffi ths et al 1999;Doust et al 2003;Blackwood et al 2004;Hardie et al 2005). This is, in part, due to the fact that cyclosporine shows inter-and intra-patient variability in the rate of absorption and metabolism, necessitating blood tests during treatment to ensure trough serum concentrations are within the reported therapeutic range of 400-600 ng/ml Patricelli et al 2002;Doust et al 2003).…”

“…but, to the best of the author's knowledge, this has not been further substantiated. AF affects male and female dogs and neutered and entire animals but the effect of sex hormones on the development and maintenance of AF is uncertain and this issue is still debated (Killingsworth et al 1988b;Day and Weaver 1992;Ellison et al 1995;Harkin et al 1996;Griffi ths et al 1999;Tisdall et al 1999;Jamieson et al 2002;Mouatt 2002;Patricelli 2002;House et al 2003;O'Neill et al 2004;Hardie et al 2005).…”

“…This, combined with variable and often disappointing surgical success rates, especially with respect to lesion recurrence and the development of faecal incontinence, has led to wider use of immunosuppressive drug therapy for the treatment of canine AF in recent times. However, medical therapies, too, have yet to be refi ned with respect to affordability, effi cacy and morbidity (Gregory et al 1991;Dahlinger et al 1998;Woolridge et al 1998 Griffi ths et al 1999;Plumb 2002;Doust et al 2003;Blackwood et al 2004;Hardie et al 2005).…”