Evaluating the use of cytosine arabinoside for treatment for recurrent canine steroid‐responsive meningitis‐arteritis

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p>Relapses in steroid-responsive meningitis-arteritis (SRMA) are frequently observed but specific treatment protocols to address this problem are sparsely reported. Standard treatment includes prolonged administration of glucocorticoids as monotherapy or in combination with immunosuppressive drugs. The aim of this study was to assess the safety and efficacy of cytosine arabinoside (CA) in combination with glucocorticoids for treatment of SRMA relapses in 12 dogs on a retrospective basis.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Dogs with recurrent episodes of SRMA and treated with a combination of CA and prednisolone were included. Information about clinical course, treatment response and adverse events was collected from medical records. Ethical approval was not required for this study.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Ten dogs (10/12) responded well to the treatment with clinical signs being completely controlled. One dog is in clinical remission, but still under treatment. One dog (8%) showed further relapse. Mean treatment period was 51 weeks. Adverse events of variable severity (grade 1–4/5) were documented in all dogs during treatment according to the veterinary cooperative oncology group grading. Three dogs developed severe adverse events. Laboratory findings showed marked changes up to grade 4. Diarrhoea and anaemia were the most often observed adverse events (6), followed by dermatitis (4), alopecia (3) and pneumonia (3). Including blood chemistry changes (13), 50 adverse events were found in total.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Treatment with CA and glucocorticoids resulted in clinical remission in 10/12 dogs, but a high incidence of adverse events occurred requiring additional measures. All adverse events could be managed successfully in all cases.</jats:p></jats:sec>

Successful surgical and medical treatment of a severe, acute epidural bleed in a young dog due to steroid responsive meningitis-arteritis

“…Moreover, a negative effect on wound healing or rather an antiproliferative effect due to the administration of cytarabine was only demonstrated on ocular tissues in vitro and in vivo (rabbits) [ 24 , 25 ]. For all these reasons, its use in our patient was considered beneficial and it indeed proved to be an effective therapeutic alternative to corticosteroids in the acute phase of SRMA, which correlates with a previous study [ 10 ]. The dog showed a fast improvement of clinical signs and no post-operative complications were observed.…”

“…With the protocol used here, side effects are very infrequent, nevertheless myelosuppression and gastrointestinal toxicity can occur [ 16 , 17 ]. Indeed, even if thrombocytopenia has been described in dogs and humans as a consequence of myelosuppression, this occurs only at higher doses than the one used in this report or if cytarabine is used as part of a combination chemotherapy protocol [ 10 , 18 – 20 ]. In contrast to corticosteroids, a further influence of cytosine arabinoside on coagulation has not been described so far.…”

“…For the acute as well as for the chronic or refractory cases, a combination of azathioprine and glucocorticoids has also proven effective [ 8 , 9 ]. For relapses, the efficacy of a combination of prednisolone and cytosine arabinoside has been demonstrated as well [ 10 ]. In one study, mycophenolate mofetil has been also used for the treatment of dogs with relapses [ 6 ].…”

A shortened whole brain radiation therapy protocol for meningoencephalitis of unknown origin in dogs

“…As in MUO, immunosuppression by prednisolone is considered the mainstay therapy ( 50 ). Few data on the management of relapsing SRMA cases is available, using medications in conjunction to prednisolone that are also described in MUO ( 50 – 52 ). One of these studies has shown, that increasing prednisolone dosage was not sufficient to control clinical signs in 40% of the cases ( 51 ).…”

Magnetic resonance imaging highlights the meningeal involvement in steroid responsive meningitis-arteritis and suggests the inflammation of the surrounding tissues (70 cases)

“…There are no definitive ante-mortem diagnostic tests for SRMA (14). Nowadays the diagnosis is based on a patient's particular signalment, medical history, neurological examination, bloodwork and, above all, cerebrospinal fluid (CSF) analysis.…”