Azathioprine vs ciclosporin - extraocular myositis

RE: Azathioprine vs ciclosporin - extraocular myositis

Virginia Campbell — Fri, 23 Sep 2016 21:43:31 GMT

Thanks for update, hope it continues to do well.

RE: Azathioprine vs ciclosporin - extraocular myositis

Beats — Fri, 23 Sep 2016 20:36:31 GMT

[quote user="Virginia Campbell"]Let us know how the mycophenolate goes. Roughly how much does it cost if you don't mind me asking?[/quote]

Update: Dog doing very nicely now. Pred dose was continued at 1mg/kg once daily and this has been tolerated OK, though still some D+ controlled with bland diet, kaolin/prebiotic paste and atetntion to avoiding scavenging. Mycophenolate was given at 10mg/kg q12hrs on empty stomach (in mouthful of food) for 3 weeks and bloods checked today prior to having this dose halved to once daily, then plan to start cutting preds in a week's time is plan to-date and see where are at that stage.

Myfenax (TEVA) 250mg capsules come in at about 20p per capsule to client, so about the same cost as using azathioprine for this patient. Whether they have actually benefited the patient in any way is harder to know.

RE: Azathioprine vs ciclosporin - extraocular myositis

grumpyoldman — Sun, 04 Sep 2016 23:07:58 GMT

I think the Azathioprine was the best advice. I had one a few years ago in a pregnant whippet bitch which appeared to resolve post whelping , if the blink is restricted by exophthalmia probably worth lots of lubricants ,maybe worth thinking about sub conjunctival injectables instead of oral meds?.

RE: Azathioprine vs ciclosporin - extraocular myositis

Virginia Campbell — Sun, 04 Sep 2016 18:28:26 GMT

[quote user="Beats"]

What I'm not sure on is what happens if you just don't treat this fully. presumably eventually the myositis subsides to atophic fibrosed muscle

[/quote]

I haven't seen periocular myositis but I bet you're right. The trouble with MMM and I suppose your case as well, is that the only way you know if you aren't using sufficent doses of whatever you're using, is by seeing appreciable and irreversible change. Most annoying and leaves us stuck between our habitual tendency of wanting to use the lowest effective dose of a drug, and the opposite approach of battering it with as much as you think you can get away woth without causing SEs. And the trouble with drugs like aza is that you only find that individual's tolerance limit when you cause a pancreatitis or whatever. Not a nice way to fine tune doses! And just scares owners (and me) off drugs.

There is a nice recent rounds on VIN about the use of ciclosporin for various types of immune mediated dz (including IBD which is a new one on me). The US based author pointed out the very individual pharmacodynamics and kinetics and advocated blood testing to identify those dogs which needed much higher doses, but AFAIK this testing isn't commercially available here so that's a bummer.

Let us know how the mycophenolate goes. Roughly how much does it cost if you don't mind me asking? Immunosuppressive doses of ciclosporin for a Golden Retriever would be financially very hard going for a lot of our owners so it's nice to hear about people's experiences with other options.

RE: Azathioprine vs ciclosporin - extraocular myositis

Beats — Sat, 03 Sep 2016 17:43:32 GMT

Thanks Stephen!

Managed to corner a medic and they advised that probably best to try something else other than preds rather than persevere with them, but no guarantees something else would actually work.

Choices of azathioprine, mycophenolate or ciclosporin were all reasonable choices so just take your pick really. Medic i spoke to preferred azathioprine/mycophenolate to ciclosporin for this. pushed further he would personally use mycophenolate rather than azathioprine as he has personally had less bother with side effects with this. Started mycophenolate mofetil 250mg (TEVA) capsule twice daily on empty stomach this morning with view to weaning preds after 5 days or so and monitoring blds in 2wks.

What I'm not sure on is what happens if you just don't treat this fully. presumably eventually the myositis subsides to atophic fibrosed muscle which, unlike in MMM, presumably wouldn't actually be a major problem to the dog?

The medic also mentioned zygomatic salivary gland infection as a differential and can CT scan for this, but agreed this sounded pretty unlikely in this case...

RE: Azathioprine vs ciclosporin - extraocular myositis

Stephen Courtney — Sat, 03 Sep 2016 16:29:55 GMT

I'd suggest calling a medicine specialist for advice - it shouldn't be too dissimilar to the protocols for any other auto immune process.

Choices are usually variations on the theme of preds, ciclosporine or mycophenolate usually, but sometimes other cytotoxic type drugs can be used so there may be other options too