Potential therapeutic effects of GS-441524 and GC376 in cats with feline infectious peritonitis

Abstract

PICO question
 In cats with feline infectious peritonitis (FIP), does treatment with the nucleoside analogue GS-441524 or the protease inhibitor GC376, compared to supportive measures alone, lead to longer survival times?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Five studies, including four uncontrolled interventional studies and one case-series were critically reviewed
 Strength of evidence
 Moderate
 Outcomes reported
 The reviewed studies collectively provide moderate evidence in support of the application of GS-441524 or GC376 to extend the survival time of cats suffering from feline infectious peritonitis
 Conclusion
 While these antiviral drugs are considered the most likely options for FIP treatment, more robust evidence should be obtained through well-designed randomised controlled trials to verify the observed positive effects in treating various forms of the disease and the potential long-term side effects. However, the ethical dilemmas of conducting double blinded placebo-controlled trials, which by necessity include untreated cats with an invariably fatal disease are recognised
 
 How to apply this evidence in practice
 The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
 Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
 

Feline Infectious Peritonitis: European Advisory Board on Cat Diseases Guidelines

“…If prompt treatment with antivirals, typically the nucleoside analogue GS-441524, is not given, FIP has a very poor prognosis with a short survival time [ 27 , 37 ]. The recent development and availability of curative antiviral treatments [ 17 , 19 , 20 , 24 , 31 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ] have revolutionised the approach to, and outcome of, FIP, although these treatments are often expensive and not legally available in all countries. Clinicians are now in need of diagnostic tools to help determine the likelihood of a diagnosis of FIP quickly [ 36 ] so that effective antivirals can be used as soon as possible in countries in which antivirals are available.…”

Active learning for an evidence-based veterinary medicine course during COVID-19

“…At the end of the second cohort, we compiled the results of all the groups addressing the same PICO and submitted the results for publication to Veterinary Evidence. One paper has been published (23), and the other is under review.…”