Clinical efficacy and safety following dose tapering of ciclosporin in cats with hypersensitivity dermatitis

Abstract

Objectives This study was designed to evaluate the efficacy and safety of reducing ciclosporin (CsA) dosing frequency from daily to every other day (EOD) or twice a week (TW) according to clinical response in cats with hypersensitivity dermatitis (HD) and treated with CsA. Methods One hundred and ninety-one cats with HD were given 7 mg/kg CsA daily for at least 4 weeks. Depending on clinical response, the dosing frequency was tapered from daily to EOD over the next 4 weeks and further to TW for an additional 4 weeks. Safety was evaluated through physical examinations, clinical pathology and the monitoring of adverse events (AEs). Results The majority of cats were able to have their dose of CsA tapered to either EOD (15.5%) or TW (62.9%) according to the clinical response. Observed AEs were most frequently mild and self-limiting vomiting and diarrhea. A higher percentage of AEs occurred with daily administration (73%) compared with other dosing regimens (27%). Conclusions and relevance Following 4 weeks of daily dosing at 7 mg/kg, CsA may be tapered to EOD or TW while maintaining the desired therapeutic response in cats with HD. Additionally, CsA appears to be well tolerated with fewer AEs at EOD or TW dosing. Establishing the lowest effective dosing frequency of CsA improves the drug's safety profile.

Treatment of the feline atopic syndrome – a systematic review

“…Based on the available evidence in a large number of cats with FASS, ciclosporin at a dose of 7 mg/kg once daily is efficacious in the treatment of reaction patterns caused by FASS (QOE 1; SOR A). In more than half of the cats, ciclosporin could be tapered from daily to twice‐weekly administration 46,88 . By contrast, there is insufficient evidence to recommend ciclosporin for feline asthma.…”

Ciclosporin and the cat: Current understanding and review of clinical use

“…38 However, most of these adverse effects are rare and not likely to be directly caused by CsA. 38 In experimental studies using CsA at higher doses (up to five times the normal dose), peripheral lymphadenopathy was reported, 44 and death occurred in one cat with a very high trough CsA concentration and bone marrow hypocellularity. 40 In three cats undergoing renal transplantation and given CsA at 5 mg/kg Po q12h, together with prednisone at 0.25 mg/kg Po q12h, haemolytic uraemic syndrome has been described.…”

“…33,39 In experimental studies using CsA at higher doses (up to five times the normal dose), aplastic anaemia, lymphopenia, prolonged activated partial thromboplastin time, reduced total proteins and increased cholesterol, creatinine and BUN were also occasionally reported. 40,44…”

“…During CsA treatment, physical examination, body weight check, haematology and biochemistry should be performed every 6 months. 6,32,44 Chronic allergic dermatitis Many studies have reported on the effectiveness of CsA in chronic allergic dermatitis (Figure 3), and these are summarised in Table 2. CsA treatment was also used to validate systems for scoring the severity of lesions in allergic cats.…”

Immunsuppressive Therapie bei Hunden und Katzen. Eigenschaften von Wirkstoffen und ihre Anwendung bei verschiedenen immunvermittelten Erkrankungen

“…Tag erfolgen. Nach weiteren 4 Wochen lässt sich die Dosis auf bis zu zwei Gaben pro Woche reduzieren (89). Ciclosporin ist mit topisch und systemisch applizierten Glukokortikoiden bei Hunden mit atopischer Dermatitis am effizientesten und die Wir-kung am besten in Studien belegt (76).…”