EPIC trial

RE: EPIC trial

Kathryn Burton — Thu, 16 Jun 2016 14:33:31 GMT

Thanks very much Nikki. It sounds like it suggests pimobendan is useful in ACVIM stage B2 dogs - will look out for something being published :-)

RE: EPIC trial

nikki — Thu, 16 Jun 2016 12:35:16 GMT

Summary so far from Adrian Boswood - he is going to expand later in the week.

Dogs that were enrolled in the EPIC study (Evaluating pimobendan in Cardiomegaly) had to meet three heart size criteria. They needed an LA:Ao of 1.6 or greater, a VHS of > 10.5 and a "normalised left ventricular internal diameter in diastole of 1.7 or greater. Dogs that met those inclusion criteria had an approximately one third lower risk of going into heart failure if they were receiving pimobendan. The effect was highly significant - so, in conclusion, if the dog definitely has a big heart including an LA:Ao of 1.6 or more it will probably do better if it goes onto pimobendan.

RE: EPIC trial

Martin Atkinson — Mon, 13 Jun 2016 17:47:44 GMT

[quote user="Thomas Johnson"]it sounds like it confirms that pimobendan delays the onset of cardiac failure, not that pre-emptively treating with any other drug delays the onset of cardiac failure.[/quote]Slight misunderstanding here Thomas. The EPIC trial does indeed show that treating with pimobendan delays the onset of cardiac failure but they only tested for pimobendan.

My experience tells me that ACEi also has this benefit in cats although I've stopped using it in dogs for this purpose because of the potential harm outweighing benefit and pimobendan seems to do the job better. And no Mr Mills I don't have peer reviewed double blinded trials to prove itjust experience. So don't anyone go away and follow the Atko protocol I don't want to get the blame it something goes tits up.

RE: EPIC trial

Thomas Johnson — Mon, 13 Jun 2016 16:12:10 GMT

[quote user="Martin Atkinson"]

Basically it confirmed what I always knew but cardiologists were in denial about: that preemptively treating dogs (and cats) with murmurs and cardimegaly before they developed cardiac failure delayed the onset of said failure. The difference is I now use Pimobendan rather than an ACEi.

[/quote]

Not really, it sounds like it confirms that pimobendan delays the onset of cardiac failure, not that pre-emptively treating with any other drug delays the onset of cardiac failure.

RE: EPIC trial

David Mills — Mon, 13 Jun 2016 13:54:59 GMT

[quote user="Martin Atkinson"]

[quote user="David Mills"]AFAIK the trial hasn't been published yet. [/quote]AFAIA the trial involved giving Pimobendan at the stage at which there were the first measurable changes. For me that would be when there is a murmur, VHS >9.5 and increasing, NT-proBNP >1900 +/- changes on echo.[quote user="David Mills"]

There's nothing in the study about cats, whose cardiological problems are fundamentally different to dogs with MMVD.

Basing treatment decisions on a nod and a wink at a bar and your own confirmation bias does not constitute good cardiology.

[/quote]Well experience does count and I know you will publically shoot me down in flames from your cardiology ivory tower but my experience shows that preemptively treating cats as well as dogs has prolonged the time before they show clinical signs of heart failure and I will continue to do so. I didn't need an EPIC trial to tell me this.

[/quote]

I suspect "Thinking. Fast and slow" by Daniel Kahnemann would be lost on you.

Not some basic spelling though. Publicly. Those pesky 11+ eh?

RE: EPIC trial

Martin Atkinson — Mon, 13 Jun 2016 13:03:23 GMT

There's nothing in the study about cats, whose cardiological problems are fundamentally different to dogs with MMVD.

Basing treatment decisions on a nod and a wink at a bar and your own confirmation bias does not constitute good cardiology.

RE: EPIC trial

David Mills — Mon, 13 Jun 2016 12:36:52 GMT

AFAIK the trial hasn't been published yet. It was stopped early as at interim analysis the results had reached the threshold that it would have been unethical to continue.

It was looking at whether pimobendan delayed the onset of CHF in dogs with MMVD, with positive results. However we do not know yet - until the paper is published - at what stage it is likely to be beneficial (it could be all stages, it could be restricted to those with remodelling or atrial enlargement), how beneficial it is, and how rigorous, extrapolatable, or compelling the evidence is.

There's nothing in the study about cats, whose cardiological problems are fundamentally different to dogs with MMVD.

Basing treatment decisions on a nod and a wink at a bar and your own confirmation bias does not constitute good cardiology.

There is no evidence that ACEis are of benefit before the onset of cardiac failure in our patients. In some, they may be harmful.

RE: EPIC trial

Kathryn Burton — Mon, 13 Jun 2016 11:00:40 GMT

I went to some cardiology CPD last week and the speaker said the results were due to be released at ACVIM that week... Maybe some further data following on from what came out last year?

RE: EPIC trial

Martin Atkinson — Mon, 13 Jun 2016 10:42:45 GMT

The result of the EPIC trial was out over a year ago (4pm Saturday 14th March 2015 to be precise). How do I know this? I was on Snowscene conference with Mark Patterson as speaker and he came up to me in the bar at 4.01 and said you are officially the first person not directly associated with the trial to know the result. Now that is what you call up-to-the-minute CPD! So unless this is a new one using ACEi rather than Pimobendan then you're a tad late and if it is I eat humble pie.

RE: EPIC trial

Hannah Wynne Richards — Mon, 13 Jun 2016 07:36:41 GMT

We were taught that the sooner you started treatment after detecting the murmur, the better. You would then stop the heart muscle from gettng strtched like a piece of old knicker elastic.

The "experts" then said there was no advantage in early treatment. It now seems they're going back to their original position (sigh)

I think EPIC refers to the epic scale marathon the experts are going on - in order to get back to where they started!

Wynne

RE: EPIC trial

nikki — Sun, 12 Jun 2016 20:28:51 GMT

The P in EPIC is for pimobendan so am currently slightly confused because so far on the course we've been doing they implied the new info we'd get this week was about using ACEI in pre-clinical MVD cases which I thought was weird because always thought it was a trial on pimobendan. I've just asked for an update as so far the notes published for this week haven't mentioned the EPIC trial at all so fingers crossed Adrian will update us soon.

RE: EPIC trial

Andrew Kent — Sun, 12 Jun 2016 20:17:09 GMT

Im no cardiologist but I thought EPIC was to do with the use of pimobendan rather than ACIi.

The press release at the point the trial was terminated is here:

http://www.rvc.ac.uk/news-and-events/rvc-news/global-clinical-trial-into-effects-of-pimobedan-in-dogs-with-cardiomegaly-epic

RE: EPIC trial

Kathryn Burton — Sun, 12 Jun 2016 19:59:18 GMT

Thanks, be interested to hear what Adrian says!

RE: EPIC trial

nikki — Sat, 11 Jun 2016 22:55:41 GMT

The general gist as I gather is to treat with ACEI in animals with stage B2 MVD (dogs with a heart murmur and cardiomegaly but no clinical signs of CHF). I'm doing a cardiology course with the RVC at the moment and Adrian Boswood is going to give us some more info on the findings this week.