Prognostic Prediction for Therapeutic Effects of Mutian on 324 Client-Owned Cats with Feline Infectious Peritonitis Based on Clinical Laboratory Indicators and Physical Signs

Abstract

Feline infectious peritonitis (FIP) is a fatal disease classified as either effusive, non-effusive (‘dry’), or a mixture (‘mixed’) of the forms of FIP, with mixed showing signs of both effusive and dry. To determine whether the therapeutic effect of Mutian on dry and mixed FIP can be predicted using clinical indicators before starting treatment, we entered 161 cats with mixed FIP and 163 cats with dry FIP into this study. Physical assessments, the reverse transcriptase-PCR detection of viral genes, and clinical laboratory tests (hematocrit, albumin/globulin ratio, serum amyloid A, α1-acid glycoprotein, and total bilirubin) were performed before Mutian was administered. These indicators were compared between the FIP groups that survived after receiving Mutian for 84 days and those that died before the completion of treatment. Significant differences in body temperature, appetite, and activity scores were confirmed between the surviving and non-surviving groups. The therapeutic effect was insufficient when total bilirubin levels increased in cats with the mixed form. In both of the FIP types, therapeutic effects were difficult to obtain when neurological clinical signs were observed. The therapeutic effects of Mutian on the cats with dry and mixed FIP can be predicted based on pre-treatment body temperature, appetite scores, and activity scores, as well as the presence of neurological signs.

Retrospective study and outcome of 307 cats with feline infectious peritonitis treated with legally sourced veterinary compounded preparations of remdesivir and GS-441524 (2020–2022)

“…The legality of the drugs has facilitated access to data relating to direct veterinary input into the care of these cats. In agreement with previous studies 10,11,22,[28][29][30][31][32][33]40,42 reporting the use of varied (usually unregulated or illegal) nucleoside analogue preparations, in the present study, all three treatment protocols (ie, remdesivir alone, remdesivir then GS-441524 and GS-441524 alone) were highly effective in treating this previously fatal disease. An impressive 88.6% of cats were alive at the end of the initial treatment period, and 84.4% at the longest follow-up time point after completion of the initial treatment period (ie, at a median [range] of 180 [0-730] days).…”

“…One study limitation and interesting discussion point is that only 9.5% of cats in the study met the stringent diagnostic criteria that confirms a diagnosis of FIP, with only another one-third of cats (33.2%) having FCoV RNA detected in samples, leading to a diagnosis of FIP being 'very likely', the remainder being highly suspicious. This lack of definitive diagnosis in many cats is not dissimilar to other studies on the outcome of cats treated for FIP 10,11,22,[29][30][31][32][33]40 because, increasingly, financial resources for treatment are being prioritised over those to confirm the diagnosis, and the ability to perform further diagnostic testing in a case can be problematic due to access to testing or the condition of the cat. A positive response to treatment in suspected cases of FIP is sometimes used as strong diagnostic support for FIP.…”

“… 30 Since then, evidence has mounted for the efficacy of GS-441524, administered increasingly by the oral route, in large numbers of cats with FIP, although the preparations used have been unlicensed and unregulated, meaning that the content and purity of any GS-441524 within them and administered to cats was not known or determined. 10 , 11 , 22 , 31 – 33 Indeed, in one report of the treatment of cats with GS-441524, independent analysis of the unregulated preparation used to treat the 18 cats showed it to contain more than double the dose of GS-441524 than the manufacturer implied on the label, 34 and similar findings were reported in another study, 35 showing that it is not possible to determine the actual doses used of unlicensed or unregulated products, making generalised treatment recommendations very difficult. Despite these limitations, it is clear that oral GS-441524 treatment of FIP is effective; all 18 cats (16 with effusions) recovered in a prospective study using 84 days of oral GS-441524 treatment.…”

Molnupiravir treatment of 18 cats with feline infectious peritonitis: A case series

“…As a result, many cats with FIP are treated with nonapproved GS‐441524 and concerns have been raised regarding the quality, purity, and potency of nonapproved products that are available on the global market. Mutian has excellent efficacy and safety 11‐14 . Although the chemical structure of the active ingredient and its accurate concentration have not been disclosed by the manufacturer, its active ingredient is GS‐441524 12 …”

“…Mutian has excellent efficacy and safety. [11][12][13][14] Although the chemical structure of the active ingredient and its accurate concentration have not been disclosed by the manufacturer, its active ingredient is GS-441524. 12 Molnupiravir is a nucleoside antiviral prodrug suitable for oral administration, with activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease (COVID-19), and has been approved in Japan since 2021 for the treatment of people with COVID-19.…”