Randomised controlled trial of fractionated and unfractionated prednisolone regimens for dogs with immune‐mediated haemolytic anaemia

Abstract

MethodsA randomised non-blinded non-inferiority trial was conducted to determine whether treatment with an unfractionated regimen of oral prednisolone was inferior to a fractionated regimen for dogs with primary immune-mediated haemolytic anaemia. Dogs received the same total daily dose of prednisolone as unfractionated (group 1, starting at 4 mg/kg orally once daily) or fractionated (group 2, starting at 2 mg/kg orally twice daily) doses. Questionnaires were administered to owners to assess adverse effects and quality of life (QoL). End points included survival to eight weeks, and changes in QoL and clinicopathological parameters over time.ResultsThirty-nine dogs were enrolled in the study, of which 5 were withdrawn and 17 were assigned to each group. The number of cases recruited was insufficient to determine whether unfractionated treatment was inferior to fractionated. Total serum bilirubin decreased more rapidly in dogs in group 2, whereas polydipsia improved more rapidly in group 1. Blood pressure and score for polyuria were higher in dogs in group 2 over time, whereas lymphocyte concentration was lower.ConclusionAdministration of the same total daily dose of prednisolone as an unfractionated dose resulted in fewer adverse effects but the effect on survival could not be assessed in this study.

Cross-sectional study of approaches to diagnosis and management of dogs with immune-mediated haemolytic anaemia in primary care and referral veterinary practices in the United Kingdom

“…Glucocorticoids are used widely in veterinary practice, with approximately 25% of non-vaccine consultations in PCPs in the UK resulting in their systemic administration [ 24 ]. However, use of glucocorticoids at immunosuppressive dosages produces severe adverse effects, which may impair quality of life [ 8 , 25 – 27 ]. For this reason, in the recent ACVIM consensus statement on treatment of IMHA, panel members recommended against exceeding an initial dosage of 3 mg/kg per day, with some indicating they did not see an indication for more than 2 mg/kg per day owing to the presumed risk of severe adverse effects without any additional clinical benefit [ 2 ].…”

Investigation of single‐nucleotide polymorphisms in the NR3C1a glucocorticoid receptor gene in Cocker Spaniels with primary immune thrombocytopenia

“…There is also variability in the severity of adverse effects observed in treated dogs, with some owners perceiving glucocorticoid adverse effects to have life‐limiting impact on their dogs, whereas others report no adverse effects. 12 , 13 …”

Prednisolone-induced diabetes mellitus in the cat: a historical cohort

“…To avoid development of GIDM in people it has been suggested to start in the lower end of the dose range and to reduce the administration frequency to once daily or every other day once the underlying disease is controlled 6,12,13 . Recently, it has also been shown in dogs that once daily administration of prednisolone was associated with less side effects than twice daily dosing 14 . Although no clear dose range has been established in cats, it is likely that cats would benefit from a low-end starting dose and probably also reduction in administration frequency to reduce the risk of side effects.…”

“…6,12,13 Recently, it has also been shown in dogs that once-daily administration of prednisolone was associated with fewer side effects than twice-daily dosing. 14 Although no clear dose range has been established in cats, it is likely that cats would benefit from a low-end starting dose and probably also reduction in administration frequency to reduce the risk of side effects. The majority of the cats in our study developed PIDM within 3 months of initiation of therapy, which further supports a dose-dependent relationship.…”