Evaluation of a low‐dose desoxycorticosterone pivalate treatment protocol for long‐term management of dogs with primary hypoadrenocorticism

Abstract

Background Lowering the dose of desoxycorticosterone pivalate (DOCP) for the treatment of dogs with primary hypoadrenocorticism (PH) decreases costs and could lead to increased owner motivation to treat their affected dogs. Objective To evaluate the efficacy of a low‐dose DOCP treatment protocol in dogs with PH. Animals Prospective study, 17 client‐owned dogs with naturally occurring PH (12 newly diagnosed, 5 previously treated with fludrocortisone acetate [FC]). Methods Dogs with newly diagnosed PH were started on 1.5 mg/kg DOCP SC; dogs previously treated with FC were started on 1.0‐1.8 mg/kg DOCP SC. Reevaluations took place at regular intervals for a minimum of 3 months and included clinical examination and determination of serum sodium and potassium concentrations. The DOCP dosage was adjusted to obtain an injection interval of 28‐30 days and to keep serum electrolyte concentrations within the reference interval. Results Median (range) follow‐up was 16.2 months (4.5‐32.3 months). The starting dosage was sufficient in all but 2 dogs and had to be significantly decreased after 2‐3 months to a median dosage (range) of 1.1 mg/kg (0.7‐1.8). Dogs 3 years of age or younger needed significantly higher dosages compared to older dogs. None of them, however, needed the 2.2 mg/kg DOCP dosage, recommended by the manufacturer. Conclusions and Clinical Importance A starting dosage of 1.5 mg/kg DOCP is effective in controlling clinical signs and serum electrolyte concentrations in the majority of dogs with PH. An additional dose reduction often is needed to maintain an injection interval of 28‐30 days. Young and growing animals seem to need higher dosages.

Low‐dose desoxycorticosterone pivalate treatment of hypoadrenocorticism in dogs: A randomized controlled clinical trial

“…Young and growing dogs might require higher DOCP dosages, but this association has not been studied in detail. [13][14][15] In addition, the majority of dogs in our study were medium and large breed dogs. The 2 dogs that developed hyperkalemia were the only 2 dogs that were <10 kg, 1 of which was the juvenile dog.…”

“…These results further support previous findings that lower starting and maintenance DOCP dosages can be used to treat most dogs with HA. 13 , 15 The manufacturer‐recommended starting dosage for DOCP is 2.2 mg/kg q25d. 11 , 12 The recommended approach for adjusting the DOCP protocol is to alter the dosage by 0.1 to 0.2 mg/kg based on Na:K ratio, or alternatively, to alter the dosing interval by several days based on Na:K ratio.…”

“…Manufacturer‐recommended starting dosages (2.2 mg/kg q25d) 11 , 12 and manufacturer‐reported average maintenance dosages (1.7‐2.2 mg/kg) 11 , 12 might be higher than what is required to adequately control HA because lower dosages and longer dosing intervals have been used successfully for HA management. 13 , 14 , 15 Beyond the benefit of cost savings, the ability to utilize lower DOCP dosages or prolonged dosing intervals raises concerns that label‐dose treatment protocols might result in mineralocorticoid excess. The administration of 2.2 mg/kg DOCP to healthy dogs does result in increases in serum sodium concentrations and decreases in serum potassium concentrations and urine specific gravities.…”

“…Initial DOCP dosages of 1.5 mg/kg were reported to be effective for controlling clinical signs and serum electrolyte abnormalities in dogs with HA. 15 Our experience at the Michigan State University Veterinary Medical Center (MSU‐VMC) suggests that even lower starting and maintenance dosages are effective. 13 It is unknown how these low‐dose protocols compare with manufacturer‐recommended protocols.…”

Therapie des primären Hypoadrenokortizismus beim Hund mit niedrig dosiertem Desoxycorticosteronpivalat

“…Zum Ende der Studie lag die benötigte Dosis im Median bei 1,3 mg/kg. Unter Einbeziehung der Hunde aus der Studie von Sieber-Ruckstuhl et al [14] [14] mussten bei einem Welpen die DOCP-Dosis initial auf 1,7 mg/kg erhöhen, doch konnte sie bis zum 15. Lebensmonat langsam auf 1 mg/kg gesenkt werden.…”