Oral Cyclosporine Treatment in Dogs: A Review of the Literature

Abstract

Cyclosporine is an immunomodulatory drug used to treat an increasing spectrum of diseases in dogs. Cyclosporine is a calcineurin inhibitor, ultimately exerting its inhibitory effects on T‐lymphocytes by decreasing production of cytokines, such as interleukin‐2. Although, in the United States, oral cyclosporine is approved in dogs only for treatment of atopic dermatitis, there are many other indications for its use. Cyclosporine is available in 2 oral formulations: the original oil‐based formulation and the more commonly used ultramicronized emulsion that facilitates oral absorption. Ultramicronized cyclosporine is available as an approved animal product, and human proprietary and generic preparations are also available. Bioavailability of the different formulations in dogs is likely to vary among the preparations. Cyclosporine is associated with a large number of drug interactions that can also influence blood cyclosporine concentrations. Therapeutic drug monitoring (TDM) can be used to assist in attaining consistent plasma cyclosporine concentrations despite the effects of varying bioavailability and drug interactions. TDM can facilitate therapeutic success by guiding dose adjustments on an individualized basis, and is recommended in cases that do not respond to initial oral dosing, or during treatment of severe, life‐threatening diseases for which a trial‐and‐error approach to dose adjustment is too risky. Pharmacodynamic assays that evaluate individual patient immune responses to cyclosporine can be used to augment information provided by TDM.

DIAGNOSIS AND PALLIATIVE MANAGEMENT OF ATOPIC DERMATITIS IN A MALAYAN FLYING FOX (PTEROPUS VAMPYRUS)

“…11 Gingival hyperplasia and verrucous (papilloma-like) lesions have also been reported in conjunction with cyclosporine use. 1,11 No adverse gastrointestinal effects were noted in this bat, all renal chemistry values remained stable, and gingival hyperplasia and verrucous lesions were not observed.…”

“…1 In at least two canine studies, however, bacteriuria was not increased from baseline levels after 30 or 90 days of cyclosporine administration. 11 During the time this bat received cyclosporine, no systemic infections were identified or treated.…”

“…14 One such skin pathology, atopic dermatitis, is commonly diagnosed in domestic mammals and has been reported in captive exotic animals. [2][3][4][5]13,17 Much research has been devoted to the diagnosis and management of atopic dermatitis in domestic animals, 1,7,8,[10][11][12][15][16][17][18] and it is likely that these modalities may be applicable to other orders of mammals. This report documents the diagnosis of skin disease in a captive male Malayan flying fox (Pteropus vampyrus) and presents details of palliative therapy for presumptive atopic dermatitis.…”

“…1,7,8,[10][11][12]16 Cyclosporine is generally well tolerated and safe in domestic dogs, with the most common adverse effects reported to be gastrointestinal in origin, namely vomiting and diarrhea. 1,[9][10][11][12] In humans, renal impairment has been reported with cyclosporine therapy; thus, frequent monitoring of serum renal chemistry values is recommended. 11 Gingival hyperplasia and verrucous (papilloma-like) lesions have also been reported in conjunction with cyclosporine use.…”

Is treating anal furunculosis with 5 mg/kg ciclosporin once daily the optimal dosing schedule?

“…Improvements in clinical signs and lesions have been seen even when the dose rate has been outside of this target range (Griffiths and others 1999). The range 400 to 600 ng/ml has been used directly from the dosing strategy used in people and in dogs undergoing allograft treatment (Guaguère and others 2004); therefore, it may not be appropriate for anal furunculosis and dosing according to clinical signs may be more beneficial (Archer and others 2014). …”