Virbagen Omega

Re: Virbagen Omega

Martin Atkinson — Thu, 14 Jun 2012 19:42:57 GMT

[quote user="Stephen Courtney"]

I have never had decent results with the interferons, for ANY of their indicated, or suggested uses.

I believe, until further proof arises, that interferon is a treatment in search of a disease!

[/quote] If you are talking about human interferon you may be right but for feline recombinant omega interferon aka Virbagen Omega that is very harsh. IME it has worked very well in: CPV - reducing treatment time to 3 days from God knows how long; FeLV and FIV associated anaemia in (some) cats putting them in remission for up to 6 months; rapid reduction of symptoms of URTI in kittens; resolution of FHV conjunctivitis to acceptable levels; mixed responses in FCV associated gingivitis as discussed. What I think is the most exiting use is in pre-vaccinated kittens with FHV which you know will probably otherwise become lifelong carriers, treated and symptomless with no other therapy in 3 days with a real possibility that they are cured and will not develop to carrier status and at the doses required to treat <1kg kittens it is even economical. It has its uses.

Re: Virbagen Omega

Stephen Courtney — Thu, 14 Jun 2012 18:16:07 GMT

I have never had decent results with the interferons, for ANY of their indicated, or suggested uses.

I believe, until further proof arises, that interferon is a treatment in search of a disease!

Re: Virbagen Omega

Evelyn Barbour-Hill — Thu, 14 Jun 2012 17:38:48 GMT

[quote user="Martin Atkinson"]PS You didn't nit pick like this over my article on this subject that you published in your journal. [/quote]

a) didn't need to

b) was wearing my Editor's Hat at the time

Re: Virbagen Omega

Rachel Perry — Thu, 14 Jun 2012 12:35:10 GMT

[quote user="Rob Davis"]Edit: posted at the same time as Rachel, who has explained things much more expertly than I![/quote]

Ah, but you were much more succinct!

Re: Virbagen Omega

Rob Davis — Thu, 14 Jun 2012 12:11:19 GMT

[quote user="Martin Atkinson"][quote user="Evelyn Barbour-Hill"]Phew. I thought for a while you meant that FCGS progressed to periodontal disease.[/quote] Doesn't it? Surely that is the exact progression, periodontal disease doesn't come out of the blue in healthy gums.[/quote]

Periodontal disease and FCGS are different diseases with different pathophysiology. Periodontal disease includes gingivitis and periodontitis depending on how far it has progressed (perodontitis and periodontal disease are often, incorrectly, used synonymously). Periodontal disease results from the host response to plaque accumulation. VERY few patients have completely healthy gums - the gingival sulcus is a constant battleground between plaque bacteria and the host defences. The degree to which periodontal disease develops depends on the individual host response and the degree of plaque control. Periodontal disease is far more common that FCGS and the former is certainly not a progression of the latter.

Edit: posted at the same time as Rachel, who has explained things much more expertly than I!

Re: Virbagen Omega

Rachel Perry — Thu, 14 Jun 2012 12:09:47 GMT

This is getting off the original discussion thread, but there appears to be some confusion surrounding these disease processes. Firstly, periodontal disease encompasses many inflammatory conditions of the periodontium (ie: gingiva, periodontal ligament, alveolar bone and cementum). The two main diseases we see are gingivitis and periodontitis. The aetiological agent of these processes is plaque- a biofilm of bacteria, combined with extracellular polysaccharides, glycoproteins. Indeed periodontitis cannot occur without gingivitis- once the gingiva is inflammed, it MAY progress to periodontitis which is typified by attachment loss for the tooth (viz: periodontal pockets, horizontal/vertical bone loss on radiography, furcational exposure etc). This will often depend on both the shift in bacteria to a more aggressive gram negative anaerobic population, but also the host's immune response to this insult. In these disease, the inflammation is typically confined to the marginal and attached gingiva (ie does not cross the mucogingival junction). Gingivitis may progress to periodontitis but doesn't always. Sometimes a static state is reached. In others (think Siamese and Greyhounds) a rapidly progressive form of periodontitis is seen. The key with these dieases is plaque control- control that and you control the disease.

Feline Chronic Gingivostomatitis is a completely separate condition. The exact cause is not known, but thought to be multifactorial. Certainly, plaque is implicated as serum Ab levels to typical anaerobes are elevated in FCGS cats, we also know that Calicivirus may play a role. The current thinking is that it is an inappropriate immune reaction to these oral pathogens/allergens (?food) that causes the typical reactions we see- ie inflammation extending beyond the mucogingival junction onto the oral mucosa, causing caudal stomatitis ("faucitis") and buccostomatitis. Many of these cats will indeed have concurrent dental disease- for example periodontitis (not suprising when we know plaque is there) and FORL (sorry to be pedantic, but the current preferred terminology for this is tooth resorption [or TR as we all like an acronym]). When performing full mouth extractions, if periodontitis or TR is found in canines/incisors, then these teeth must also be fully extracted- crown amputation is not acceptable in FCGS cats. The fauces, if you're wondering, are actually the lateral walls of the oropharynx- where the tonsils lie, not the caudal area of the mouth where mandible meets maxilla. Pedantry aside, I hope this helps to clarify what is a complicated disease process.

Re: Virbagen Omega

Martin Atkinson — Thu, 14 Jun 2012 10:39:09 GMT

[quote user="Evelyn Barbour-Hill"]Phew. I thought for a while you meant that FCGS progressed to periodontal disease.[/quote] Doesn't it? Surely that is the exact progression, periodontal disease doesn't come out of the blue in healthy gums.

[quote user="Evelyn Barbour-Hill"]I don't think I've ever seen a FCGS cat that didn't have a bit of periodontal disease. Usually a bit of periodontitis too.[/quote] This then contradicts your previous statement but is exactly what I was trying to say. However you're splitting hairs again: where does periodontitis end and periodontal disease begin surely they are manifestations of the same disease process?

PS You didn't nit pick like this over my article on this subject that you published in your journal.

Re: Virbagen Omega

Evelyn Barbour-Hill — Wed, 13 Jun 2012 22:50:41 GMT

[quote user="Martin Atkinson"]

[quote user="Evelyn Barbour-Hill"]

[quote user="Martin Atkinson"]Indeed IME the progression from gingivo-stomatitis to periodontal disease is a subtle one[/quote]

I don't understand.

[/quote] Yup I agree a bit ambiguous. What I meant to say is that there is a fine dividing line between a diagnosis of gingivo-stomatitis and periodontal disease in that many cases of G-S will have mild periodontal disease but it may not be obvious to the observer without very close examination as the gingival margin is compromised.

[/quote]

Phew. I thought for a while you meant that FCGS progressed to periodontal disease.

But I still don't understand what point it is you are trying to make.

I don't think I've ever seen a FCGS cat that didn't have a bit of periodontal disease. Usually a bit of periodontitis too.

Re: Virbagen Omega

Martin Atkinson — Wed, 13 Jun 2012 18:33:14 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Martin Atkinson"]Indeed IME the progression from gingivo-stomatitis to periodontal disease is a subtle one[/quote]

I don't understand.

Re: Virbagen Omega

Evelyn Barbour-Hill — Wed, 13 Jun 2012 16:51:55 GMT

[quote user="Martin Atkinson"]Indeed IME the progression from gingivo-stomatitis to periodontal disease is a subtle one[/quote]

I don't understand.

[quote user="Martin Atkinson"]PS I think the inclusion or exclusion of the word faucitis into the equation is pedantic, being a non-dental type I understood that faucitis implies involvement of tissue beyond the most caudal teeth into the oro-pharynx and it is an anatomical nicety to say whether it is or isn't.[/quote]

Sometimes anatomical niceties are important. Faucitis would be inflammation of the fauces. If you use the word for something else, what are you going to call it if the fauces really are inflamed?

Re: Virbagen Omega

Martin Atkinson — Wed, 13 Jun 2012 14:01:35 GMT

[quote user="Rachel Perry"]The first thing to be clear on is the distinction between chronic gingivostomatitis and severe periodontal disease. [/quote] I guess I didn't make this clear either but I didn't find much difference in relief of symptoms using Virbagen Omega either in severe FCGS or FCGS with associated periodontal disease. The most consistent improvements I've seen are with mild gingivitis and although I've recorded some spectacular improvements in cats with severe FCGS these have been in multi-modal treatments and have not been consistent. It is unlikely that I would use it as an intra-lesional injection in anything else other than animals I've GA'd to perform some dental work and all of these are likely to have some periodontal disease, so the cats that only got oral treatment would have been milder cases. Indeed IME the progression from gingivo-stomatitis to periodontal disease is a subtle one and most cats with FCGS are likely to have at least some periodontal disease as well. These can be controlled with good prophylaxis but we are all familiar with those end-stage mouths that will ultimately only respond to total extraction. As previously suggested this is a multi-factorial disease and needs a multi-modal approach and in my experience the benefits of long term oral Virbagen Omega have in general been outweighed by cost, client compliance and patient tolerance in all but the mildest cases. My interest lies more in the virology of FCV rather than dentistry so my dental terminology may be a bit iffy and I may see this from a different angle but agreed the majority of FCGS cases are FCV+ve and it is the body's immune response to the FCV that triggers the plasmocytic-lymphocytic reaction which causes inflammation and pain not the virus itself. I still think its worth a go using Virbagen Omega in cats which are not responding well to conventional treatment but I no longer expect it to delay the day when all the teeth have to come out.

PS I think the inclusion or exclusion of the word faucitis into the equation is pedantic, being a non-dental type I understood that faucitis implies involvement of tissue beyond the most caudal teeth into the oro-pharynx and it is an anatomical nicety to say whether it is or isn't.

Re: Virbagen Omega

Rachel Perry — Wed, 13 Jun 2012 13:20:45 GMT

This is using it in cats that have had full mouth extractions (performed properly with no root remnants left behind...if you're 'drilling out roots' there will be roots left behind, trust me)- but not responded. ie using it after full mouth extractions if this has not proved successful.

Re: Virbagen Omega

Mark Holmes — Wed, 13 Jun 2012 13:07:26 GMT

Excellent but to be clear that is using it in combination with full mouth extraction rather than as opposed to full mouth extraction.

Re: Virbagen Omega

Rachel Perry — Wed, 13 Jun 2012 13:02:00 GMT

Hi all,

I guess I am what some might call a 'dental type'. The first thing to be clear on is the distinction between chronic gingivostomatitis and severe periodontal disease. I have seen not an insignificant number of vets try to treat periodontitis with Virbagen. Not too surprising that it doesn't work. In FCGS, the inflammation extends beyond the mucogingival junction onto the oral mucosa (buccostomatitis) and typically includes the caudal oral mucosa (caudal stomatitis) - this is erroneously called faucitis by many vets. So, the diagnosis must be correct, and this is largely based on a good oral examination. Up to 98-100% of cats with caudal stomatitis will be Calicivirus positive. This is an association, not a cause. However, in many cats that respond to treatment, subsquent viral detection will be negative. Treatment being full mouth extractions- this implies all teeth caudal to canines in UK/Europe and all teeth in USA. Any diseased canines/incisors must be extracted- eg tooth resorption/periodontitis. It is also ESSENTIAL to remove ALL root fragments. Cats will NOT improve if roots are retained, as the inflammation will continue. A study group of European Diplomates presented their recommendations for treatment of FCGS about 3 years ago at the European Veterinary Dental Congress. Their recommendation was to perform these extractions surgically and under radiographic control. A study by Phillipe Hennet in the late 90s suggested treatment outcomes were 60% cure with full mouth extractions, 20% improve (ie better but still require some medical control) and 10% no change. It is these 10% non-reposnders that we may consider using Interferon on, and anecdotally, 50% of these respond and 50% don't.

The best evidence to date for the use of Virbagen is:

Hennet PR et al. Comparative efficacy of a recombinant feline interferon omega in refractory cases of calicivirus-positive cats with caudal stomatitis: a randomised, multi-centre, controlled, double-blind study in 39 cats. JFMS 2011: 13; 577-587

This is the abstract:

Chronic caudal stomatitis with alveolar/buccal mucositis in calicivirus-positive
cats is the most severe presentation of feline chronic gingivostomatitis.
Refractory cases are helped by antibiotic and anti-inflammatory treatments often
including glucocorticoids. In order to evaluate the comparative efficacy of
oromucosal administration of recombinant feline interferon omega (rFeIFN-u)
versus oral administration of glucocorticoids, a randomised, multi-centre,
controlled, double-blind study was performed in 39 cats. The progression of
behavioural, clinical and lesional scores was assessed over 90 days. Daily
oromucosal treatment with 0.1 MU of rFeIFN-u was associated with a significant
improvement of clinical lesions (caudal stomatitis and alveolar/buccal
mucositis) and a decrease of pain scores from D0 to D90. Although no such
statistical improvement was noticed in the prednisolone group, there was,
however, no significant difference between the two groups for most of the
parameters, except pain at D60 and D90.

In conclusion, Virbagen produced signifcant decrease in clinical lesions and pain scores from D0 to D90, and performed at least as well as short-term steroid administration. The paper has some flaws, but it is the highest level of evidence out there.

Sorry for the intial tangent, but it is essential to be clear about the diagnosis. The treatment of gingivitis is plaque control.

Re: Virbagen Omega

Martin Atkinson — Tue, 12 Jun 2012 19:26:59 GMT

[quote user="Evelyn Barbour-Hill"]

Can we just be clear.

Are we discussing feline chronic gingivostomatitis? Or gingivitis? Or both?

[/quote]

The OP asked about gingivostomatitis so I gave my experience using interferon in that but also my experience in using it in gingivitis in young cats.

Re: Virbagen Omega

Evelyn Barbour-Hill — Tue, 12 Jun 2012 18:48:09 GMT

Can we just be clear.

Are we discussing feline chronic gingivostomatitis? Or gingivitis? Or both?

Re: Virbagen Omega

Mark Holmes — Tue, 12 Jun 2012 17:30:33 GMT

So far things reflect my experience, some seem to do ok with it but then some seem to do ok without it and its difficult to be confident its made a difference.

Re: Virbagen Omega

James Laidlaw — Tue, 12 Jun 2012 17:26:46 GMT

My limited experience with using vribagen omega has never shown astounding results or convinced me of its use. I think the oral use is via making up containers of liquid that last a month, but you can freeze amounts and keep for long term use. The last cat we had on this regime got fed up with oral dosing daily, and never showed a marked improvement. I'd agree with te others that I've only seen good results when combined with dental treatment etc, which I would think is likely to make a more significant difference.

Re: Virbagen Omega

Martin Atkinson — Tue, 12 Jun 2012 17:17:08 GMT

Another of my pets subjects and on which I have frequently eulogised. My experience over many years is very equivocal. I have had cases I felt did very well with combinations of intra-lesional injections and oral dosing and others that didn't. I hoped this was the holy grail that would replace radical dentistry to treat those horrible FCV+ve lymphocytic-plasmacytic gingivo-stomatitis (LPGS) cases but sadly it proved not to be. Cases where it has been combined with radical dentistry do well but is that because of the dentistry or the interferon? This is a multi-factorial disease and it is likely that a combination of interferon, antibiotics, anti-inflammatory treatment and good dental care is necessary. The Virbagen Omega's primary mode of action may not even be due to its anti-viral properties but as much, if not more, as an immuno-modulatory agent and a judicious dose of steroids will do as well (did I really say that)?!. I would not waste my client's money any more using it as a main-stay of treatment in these chronic cases and I'm afraid that there is still no substitute for good dental care including total extraction in some cases (unless you are to believe one of our forum contributors who recommends some magic treatment which her company just coincidentally happens to market)! In any event most cases of chronic gingivitis that do respond to Virbagen Omega will require indefinite oral treatment which most clients won't comply with. The only moderate long term success I've had is in adolescent cats with FCV +ve post-eruption gingivitis which have responded to a (relatively) short course of oral treatment. This is worth considering because many of these cats will otherwise progress to LPGS in middle age but the jury is really out as whether: a) the response I see in young cats would have occurred without treatment and b) those that may have responded will regress later or not. Never say never, but despite my initial great enthusiasm on this subject, some of my work on which Virbac may be drawing, I'm afraid I would say: save the client's money and hone your dental skills. Don't forget some of these cats are also FIV+ve and that needs addressing - does Virbagen Omega work in that?, that's another story!

PS RMB enthusiasts please don't reply, we've heard it all before.

Re: Virbagen Omega

Hannah Wynne Richards — Tue, 12 Jun 2012 17:06:26 GMT

I always offer it and use it for all chronic gingivitis cases at the same time as a comprehensive dental-if the owners will pay for it !

My impression (for what it's worth ) is that cats who have it do better than cats who don't

Wynne

Re: Virbagen Omega

Noweia — Tue, 12 Jun 2012 16:51:22 GMT

Apparently the way to go is to use it orally, once or twice daily. Will have to look up full regime when I get back from work.

Re: Virbagen Omega

Thomas Johnson — Tue, 12 Jun 2012 15:26:49 GMT

[quote user="Julie Innes"]

I had another cat with a horrible case, never treated before. We extracted all his teeth and injected the virbagen into the gums, as described in some CPD notes I had, can't remember where from. That cat has done really well- 6 mths post-op and never looked back.

[/quote]

But would he have done just as well if you had just extracted the teeth and not injected the virbagen into the gums?

Re: Virbagen Omega

Julie Innes — Tue, 12 Jun 2012 14:53:15 GMT

I have tried it for a chronic gingivitis/ stomatitis, but with no success- having said which, the cat in question had been having steroid injections for years beforehand, so possibly not the best candidate.

So the answer is, I guess i don't know

Re: Virbagen Omega

Nicola Lawlor — Tue, 12 Jun 2012 14:38:41 GMT

I used to use it in cats with gingivitis/stomatitis but stopped using it in the end as I never really managed to convince myself of any patient benefit - though I have no idea what the new guidelines are and how they differ now. I would be interested to hear about the changes however especially from people using in practice.