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

Vincent, A. M.; Okonkowski, Linda K; Brudvig, Jean M.; Refsal, Kent R.; Berghoff, Nora; Olivier, N. Bari; Langlois, Daniel K.

doi:10.1111/jvim.16195

Cited by 9 publications

(12 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…More than 60% of the WEV follow the manufacturer's instructions, initiating treatment at 2.2 mg/kg. The authors suspect that this indicates a reluctance to employ lower doses, although several studies have already demonstrated that lower doses are efficacious and clinically safe [9,14,15,21]. In fact, those that use lower doses reported positive patient outcomes and fewer side effects, as reported in previous studies, highlighting that in several dogs, a lower dose can be safely considered.…”

Section: Discussionmentioning

confidence: 83%

“…After the patient has been stabilized with an appropriate dose and frequency of administration, electrolytes should be re-evaluated every 3 to 6 months [11]. Recently, some studies have suggested lowering the initial starting dose of DOCP [9,14,15] or reducing the frequency of administration [16]. These revised protocols effectively manage electrolytes and were developed out of concern by some veterinarians that standardprotocols might lead to biochemical evidence of overtreatment [15].…”

Section: Introductionmentioning

confidence: 99%

“…Recently, some studies have suggested lowering the initial starting dose of DOCP [9,14,15] or reducing the frequency of administration [16]. These revised protocols effectively manage electrolytes and were developed out of concern by some veterinarians that standardprotocols might lead to biochemical evidence of overtreatment [15]. However, it is unknown which protocols are preferred by veterinarians in general practice.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Use of Deoxycorticosterone Pivalate by Veterinarians: A Western European Survey

Rebocho

Domínguez‐Ruiz

Englar

et al. 2021

Veterinary Sciences

View full text Add to dashboard Cite

This study aims to gather knowledge about the use of deoxycorticosterone pivalate (DOCP) by Western European Veterinarians (WEV) in dogs with typical hypoadrenocorticism. An observational cross-sectional study was conducted using an online survey, translated into four languages and disseminated to veterinary affiliates and mailing lists in six countries of Western Continental Europe. Respondents were tasked to share their therapeutic approach to hypoadrenocorticism, whether they preferred DOCP or fludrocortisone and the specific practical use of DOCP. One-hundred and eighty-four responses were included. Of these, 79.9% indicated that they preferred prescribing DOCP over fludrocortisone as a first-line treatment for mineralocorticoid supplementation. A total of 154 respondents had used DOCP at least once. Eighty percent of those who reported their initial dosage prescribed 2.2 mg/kg. After starting DOCP, 68.2% of the respondents assess electrolytes 10 and 25 days after administration following manufacturer instructions. In stable dogs, electrolytes are monitored quarterly, monthly, semi-annually, and annually by 44.2%, 34.4%, 16.9%, and 4.6% of respondents respectively. When treatment adjustment is required, 53% prefer to reduce dosage while 47% increase the interval between doses. Overall, DOCP is the preferred mineralocorticoid supplementation among WEV. Reported variability underlies the need to investigate the best strategies for DOCP use and therapeutic adjustments.

show abstract

Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Use of Deoxycorticosterone Pivalate by Veterinarians: A Western European Survey

Rebocho

Domínguez‐Ruiz

Englar

et al. 2021

Veterinary Sciences

View full text Add to dashboard Cite

show abstract

“…Considering that most previous research reported that DOCP showed sufficient effects even at low dosages, this case was an unusual case and the aldosterone level was not significantly low. Therefore, as suggested by several studies, we decided to start with a lower dosage and gradually increase if needed (Bates et al., 2013 ; Sieberâ Ruckstuhl et al., 2019 ; Vincent et al., 2021 ). After the injection of DOCP, Na + and K + levels returned to normal.…”

Section: Discussionmentioning

confidence: 99%

Isolated hypoaldosteronism managed by DOCP in a dog with chronic kidney disease and hypercortisolism

Park

Kim

et al. 2022

Veterinary Medicine & Sci

View full text Add to dashboard Cite

A 13-year-old spayed female Schnauzer dog with chronic kidney disease (CKD; International Renal Interest Society stage 2, non-proteinuric, normotensive), diabetes mellitus, hypercortisolism and myxomatous mitral valve degeneration (American College of Veterinary Internal Medicine stage B2) presented with electrolyte imbalance that had progressed to hyperkalaemia and hyponatremia, with a sodium to potassium (Na:K) ratio of 19.6. Cortisol levels after the adrenocorticotropic hormone stimulation test were within the therapeutic range, but aldosterone levels were below the reference range; hence, isolated hypoaldosteronism was diagnosed. After administration of deoxycorticosterone pivalate (DOCP), the electrolyte imbalance improved with a Na:K ratio of 27.7. This is the first report of the management of isolated hypoaldosteronism and hypercortisolism using trilostane and DOCP in a dog. This case highlights the importance of recognizing isolated hypoaldosteronism after long-term treatment with trilostane in a canine patient with CKD.

show abstract

“…However, several reports have shown that dogs can be stabilized on much lower doses or longer dose intervals. 12 , 13 , 14 , 15 , 16 Reported DOCP doses in the 7 cats described in the case reports mentioned above ranged from 2.2 to 2.6 mg/kg and reported intervals from 28 to 40 days. 2 , 7 , 8 , 9 The follow‐up period of these cases is not clearly mentioned in 3 or was below 12 months in 2 cases.…”

Section: Introductionmentioning

confidence: 99%

Clinical features and long‐term management of cats with primary hypoadrenocorticism using desoxycorticosterone pivalate and prednisolone

Sieber-Ruckstuhl

Harburger

Hofer

et al. 2023

Veterinary Internal Medicne

View full text Add to dashboard Cite

Background Primary hypoadrenocorticism (PH) is rare in cats and knowledge about treatment is sparse. Objective To describe cats with PH with a focus on long‐term treatment. Animals Eleven cats with naturally occurring PH. Methods Descriptive case series with data on signalment, clinicopathological findings, adrenal width, and doses of desoxycorticosterone pivalate (DOCP) and prednisolone during a follow‐up period of >12 months. Results Cats ranged from 2 to 10 years (median 6.5); 6 cats were British Shorthair. Most common signs were reduced general condition and lethargy, anorexia, dehydration, obstipation, weakness, weight loss, and hypothermia. Adrenal glands on ultrasonography were judged small in 6. Eight cats could be followed for 14 to 70 months (median: 28). Two were started on DOCP doses ≥2.2 mg/kg (2.2; 2.5) and 6 < 2.2 mg/kg (1.5‐2.0 mg/kg, median 1.8) q28 days. Both high‐dose cats and 4 low‐dose cats needed a dose increase. Desoxycorticosterone pivalate and prednisolone doses at the end of the follow‐up period were 1.3 to 3.0 mg/kg (median: 2.3) and 0.08 to 0.5 mg/kg/day (median: 0.3), respectively. Conclusions and Clinical Importance Desoxycorticosterone pivalate and prednisolone requirements in cats were higher than what is currently used in dogs; thus, a DOCP starting dose of 2.2 mg/kg q28 days and a prednisolone maintenance dose of 0.3 mg/kg/day titrated to the individual need seems warranted. Small adrenal glands (width < 2.7 mm) on ultrasonography in a cat suspected of hypoadrenocorticism can be suggestive of the disease. The apparent predilection of British Shorthaired cats for PH should be further evaluated.

show abstract

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

Cited by 9 publications

References 27 publications

Use of Deoxycorticosterone Pivalate by Veterinarians: A Western European Survey

Use of Deoxycorticosterone Pivalate by Veterinarians: A Western European Survey

Isolated hypoaldosteronism managed by DOCP in a dog with chronic kidney disease and hypercortisolism

Clinical features and long‐term management of cats with primary hypoadrenocorticism using desoxycorticosterone pivalate and prednisolone

Contact Info

Product

Resources

About