Does Atopica delay healing of a surgical wound?

Re: Does Atopica delay healing of a surgical wound?

Rory Bell — Mon, 16 Dec 2013 16:38:56 GMT

Hi again

To balance the abstract in my previous post, and to provide some evidence to back my statement that there was some evidence to suggest that cyclosporin MIGHT affect wound healing - see below

J Endod. 2010 Jan;36(1):95-9. doi: 10.1016/j.joen.2009.10.019.

Influence of selective immunosuppressive drugs on the healing of exposed dogs' dental pulp capped with mineral trioxide aggregate.

Mahmoud SH, Grawish Mel-A, Zaher AR, El-Embaby A, Karrouf GI, Sobh MA.

Author information

Abstract

INTRODUCTION:

Immunosuppressive drugs are used in clinical medicine for a variety of disorders, but their effects on the reparative capacity of the dental pulp are unknown. This study evaluated the influence of selected immunosuppressive drugs on pulpal tissue healing after direct pulp capping of mechanically exposed dog's teeth with mineral trioxide aggregate (MTA).

METHODS:

Ten healthy male dogs were assigned into 5 experimental groups: a control group in which no drug was received and 4 experimental groups in which the immunosuppressive drugs prednisone, mycophenolate mofetil, sirolimus, and cyclosporine A were administered 45 days before the operative procedures and until the dogs were killed. Class V cavities were prepared on the buccal surfaces of 12 teeth in each dog. In each cavity, the pulp was exposed and capped with MTA. The pulpal tissue responses to capping material were assessed 65 days postoperatively.

RESULTS:

Compared with the control group, variable responses was recorded in the groups treated with mycophenolate mofetil, sirolimus, andcyclosporine A, which were characterized by moderate to severe inflammatory reactions, tissue necrosis, and total absence of hard tissue bridging. Pulpal tissue responses in the group treated with prednisone were characterized by inflammatory cell infiltration, limited tissue necrosis, as well as partial to complete hard tissue bridging.

CONCLUSIONS:

From these findings, it seemed evident that acceptable repair of the dentin-pulp complex, eg, wound healing with hard tissue formation after capping with MTA, is unlikely with mycophenolate mofetil, sirolimus, or cyclosporine A immunosuppressive drug therapy

Re: Does Atopica delay healing of a surgical wound?

Rory Bell — Mon, 16 Dec 2013 16:31:41 GMT

Hi Mike

There is some limited evidence that cyclosporine does impair wound healing in dogs. Most of the evidence we have is derived from people, using much higher doses of cyclosporin following transplant surgery. The main issue there seems to be immunosuppression leading to post op wound infections rather than a direct effect on wound healing. That experience seems to be echoed in cats following renal transplantation and immunosuppression with cyclosporin (approx 35% incidence of post op infections (mainly bacterial)).

Looking at some (fairly gut wrenching) experimental canine studies, the abstract from the one that most answers your question is included below. Interesting that the steroid / aza group performed significantly differently to the other two groups! Low numbers so I'd question the statistical power to be fair. In your patient, I'd imagine the other thing to consider would be the distinct possibility that, were you to discontinue cyclosporin, the skin lesions would relapse and the associated superficial pyoderma might pose a greater threat of post op infections than if you continued on with cyclosporin?

cheers!

rory

J Thorac Cardiovasc Surg. 1983 Jun;85(6):821-6.

A comparison between cyclosporin A and methylprednisolone plus azathioprine on bronchial healing following canine lung autotransplantation.

Goldberg M, Lima O, Morgan E, Ayabe HA, Luk S, Ferdman A, Peters WJ, Cooper JD.

Abstract

The effects of two low-dose immunosuppressive therapies upon the healing of the bronchial anastomosis and skin wounds following lung autotransplantation were evaluated. Autotransplantation was performed in three groups of dogs: Group 1 (nine dogs) received no immunosuppression, Group 2 (seven dogs) received postoperative immunosuppression with methylprednisolone (2 mg/kg) and azathioprine (1.5 mg/kg), and Group 3 (four dogs) received postoperative immunosuppression with cyclosporin A (20 mg/kg/day). Skin incisions 7 cm in length were made in the dorsal region of each dog. Dogs were put to death 23 days postoperatively, and the breaking strength of the bronchial anastomoses and skin wounds was evaluated with the Instron Universal Testing Machine, with a cross-head speed of 0.5 cm/min. Bronchial breaking strengths were similar in Groups 1 and 3 and significantly higher than in Group 2 (p less than 0.001). Skin breaking strengths were similar in Groups 1 and 3 and significantly higher than in Group 2 (p less than 0.001). Scanning electron microscopic (SEM) studies of both skin and bronchial wounds showed normal formation of collagen bundles in Groups 1 and 3 but a disorganized pattern in Group 2. Our results suggest that low-dose immunosuppression with methylprednisolone and azathioprine significantly affects wound healing and breaking strength of both bronchial anastomoses and healed skin incisions following canine lung autotransplantation. Immunosuppression with cyclosporin A had no adverse effect on either bronchial or skin healing

Re: Does Atopica delay healing of a surgical wound?

Mark Holmes — Mon, 16 Dec 2013 16:16:43 GMT

[quote user="Martin Atkinson"]

Don't know but I had a dog with deep pyoderma that was on Atopica for anal farunculosis and it appeared to make that worse.

[/quote] That's how a homeopath interprets a clinical trial. - one case irrelevant.

Re: Does Atopica delay healing of a surgical wound?

Martin Atkinson — Mon, 16 Dec 2013 14:17:50 GMT

Don't know but I had a dog with deep pyoderma that was on Atopica for anal farunculosis and it appeared to make that worse.