A prospective randomized study of efficacy of 2 treatment protocols in preventing recurrence of clinical signs in 51 male cats with obstructive idiopathic cystitis

Abstract

Background Urethral obstruction (UO) is a common complication of feline idiopathic cystitis (FIC). Robust treatment recommendations to prevent its recurrence are scarce. Objectives To evaluate meloxicam treatment for prevention of clinical recrudescence in male cats with obstructive FIC. Animals Fifty‐one client‐owned cats. Methods Prospective, randomized clinical trial. Every male cat with FIC‐associated UO was deemed eligible for the study and was recruited during hospitalization. After discharge, cats were treated with phenoxybenzamine and alprazolam for 2 weeks, with (24 cats) or without (27 cats) low‐dose meloxicam (0.025 mg/kg/day PO) and monitored for 6 months. Results Cumulative number (%) of cats with recurrent UO at 10 days, 1‐, 2‐, and 6‐months after discharge was 1 (2%), 2 (4%), 4 (8%), and 8 (16%), respectively. Overall, 12 (24%) cats experienced signs of recurrent FIC within 6 months, with (8 cats) or without (4 cats) concurrent UO. No difference in the cumulative incidence of UO within 6 months was detected with addition of meloxicam (odds ratio [95% confidence interval], 0.63 [0.13‐2.97]; P = .70). All cats were alive at 6 months. Conclusions and Clinical Importance No clinical benefit was detected with the addition of low‐dose meloxicam to phenoxybenzamine and alprazolam treatment for 2 weeks after discharge. Nevertheless, this study was underpowered to identify potential differences, and its findings must be corroborated in larger studies.

In cats which treatment, meloxicam or prednisolone, most quickly reduces clinical signs of feline interstitial cystitis?

“…51 males with urethral obstruction and FIC were allocated one of the treatment protocols in a single-blind fashion. The study drew the conclusion that the addition of low-dose meloxicam to phenoxybenzamine and alprazolam treatment did not make a significant difference in the return to urethral obstruction and/or FIC compared with cats only treated with phenoxybenzamine and alprazolam (Nivy, et al, 2019). While the reduction in clinical signs was not measured in this study, it is interesting to note that the addition of meloxicam did not provide any clinical benefit for the assessed parameters.…”

“…However, higher dose rates of 0.05 mg/kg and 0.075 mg/kg with the same dosing interval showed a statistically significant reduction in pain parameters (Carroll et al, 2011). It could therefore be possible that the dose rate chosen by Nivy et al (2019), was not high enough to be efficacious.…”

“…One other single-blinded randomised controlled trial by Nivy et al (2019), assessed the recurrence rates of FIC and rUO in cats. While this study did not answer the PICO question, the study itself does provide some interesting food for thought.…”

Are glucocorticoids or NSAIDs effective in idiopathic feline urinary tract disease signs than no treatment or placebo?

“…Osborne et al (1996), Dorsch et al (2016), and Hetrick & Davidow, (2013) did not provide details of sample size calculation nor did they present a power analysis but we can infer that statistical power was likely low. Nivy et al (2019) and colleagues performed a sample size calculation assuming a population with a much higher risk for FIC recurrence actually occurred in their trial, thus high risk for type II error was also present. primary and intuitively valid objective outcome.…”

“…primary and intuitively valid objective outcome. However, method of subjective scoring of non-obstructive cystitis signs was not transparent in two publications (Osborne et al, 1996;and Nivy et al, 2019); in the third publication (Dorsch et al, 2016), subjective scoring method was transparent but lacked detail on inter-rater reliability and validation; moreover, it is unclear how the raters were blinded.…”