Pexion

RE: Pexion

Rob Davis — Fri, 23 Sep 2016 18:35:05 GMT

That's brilliant, thanks, David

RE: Pexion

David Mills — Fri, 23 Sep 2016 13:41:19 GMT

[quote user="Rob Davis"]

[quote user="Gillian Mostyn"]

If you really look into the research papers, it really doesn't appear to be very effective at all. My colleague did, and wasnt impressed with what he found. (I've forgotten the details, and dont quote me, but something like 50% of dogs failed to show any improvement, so were simply removed from the trial at an early stage!!! Obviously, they don't appear in the final figures!)

[/quote]

I don't suppose you know where to find these papers - I would be interested to read them, particularly in the light of the current journal club paper...

[/quote]

They're mostly here:

http://www.ncbi.nlm.nih.gov/pubmed/?term=imepitoin+dog

There was a recent knowledge summary from RCVS Knowledge dealing with the main papers:

https://www.veterinaryevidence.org/index.php/ve/article/view/9

RE: Pexion

Rob Davis — Fri, 23 Sep 2016 12:29:28 GMT

[quote user="Gillian Mostyn"]

[/quote]

I don't suppose you know where to find these papers - I would be interested to read them, particularly in the light of the current journal club paper...

RE: Pexion

Bob Russell — Fri, 23 Sep 2016 09:56:00 GMT

Just to show I am looking at the Journals section!

"Results: Twenty-two of 28 (79%) dogs in the study that received placebo demonstrated a decrease in seizure frequency compared with baseline, and 8 (29%) could be considered responders, with a 50% or greater reduction in seizures. For the 3 trials evaluated, the average reduction in seizures during placebo administration relative to baseline was 26% (P= .0018), 29% (P= .17), and 46% (P= .01)."

Does that make Pexion more or less likely to be of value in treating epileptic dogs? Does not look quite so impressive perhaps. That said one of my patients is doing well on Pexion, the other 'success' has levetiracetam also. Might be worth chatting to the owner to see if they want to try the Keppra alone!

RE: Pexion

Gillian Mostyn — Fri, 23 Sep 2016 09:46:22 GMT

RE: Pexion

Karen Eggleton — Thu, 22 Sep 2016 23:32:39 GMT

Personally either I misunderstood the promotional drive or it's being subtly mis sold. Failed as a first line, admittedly in a very complicated epileptic patient. But read the data sheet with all its subtle disclaimers and speak to the technical advisors and they seem to say it's an adjunct treatment...

RE: Pexion

Bob Russell — Thu, 22 Sep 2016 11:55:48 GMT

The Journal Club paper suggests there may be a genuine placebo effect with canine epilepsy therapy so that might place doubt on its efficacy.

Epanutin etc etc had their days in the past before being shown to be largely ineffective in dogs.

RE: Pexion

Sarah Keir — Thu, 22 Sep 2016 10:51:33 GMT

Strangely, the referral centre we refer the probable idiopathic epilepsy cases to for MRI/work up, send them back on phenobarbitone despite one of their head neurologists being one of the ones on all the Pexion literature, doing webinars on how wonderful it is etc.

I have started 2 dogs on it, had to increase the dose for both and I would class them as only moderately controlled at this stage, though owner has opted to stay with it as she works for Boehringer! Also the side effects sound like they are just the same as with phenobarb.

RE: Pexion

ChrisBVSc — Tue, 20 Sep 2016 12:40:15 GMT

It's a very 'easy' drug to use, and I've found it to be effective in the majority of cases so far. Still had the odd one requiring phenobarb or something else, but well worth trying as a first line drug.

A neuro specialist I spoke to a while ago suggested you may have an improved response rate starting them around 15-20mg/kg rather than the 10mg/kg in the datasheet, just incase that's of any use to you. (max recommended dose is 30mg/kg)

RE: Pexion

Rob Davis — Sat, 17 Sep 2016 10:03:57 GMT

Many thanks for the replies, I will discuss with the owner.

RE: Pexion

grumpyoldman — Thu, 15 Sep 2016 00:06:18 GMT

Used it a lot now ,not perfect but better than phenobarb in new animals, less effective in cases with a history of prolonged tonic /clonic grand mal activity on its own, a lot better with levitiracetam , and no monitoring which can be a double edged sword as they drop off the monitoring radar and want internet prescriptions all the time when stable.

Does not seem to cope well shunt/metabolic seizure activity

RE: Pexion

Rob Loxley — Wed, 14 Sep 2016 21:16:16 GMT

I'd happily start new cases on it - simple, well tolerated, fast acting, low monitoring needed - but (maybe like any antiepileptic) be prepared to change drug if not controlling. My gut feeling is that pheno is more likely to control fits, but for the dogs Pexion works in it's a good option

RE: Pexion

Thomas Johnson — Wed, 14 Sep 2016 16:28:05 GMT

[quote user="Rob Davis"]

I have a newly diagnosed idiopathic epilepsy patient (4yo otherwise healthy spayed husky). I have not used pexion previously and am interested in others' experience. Having read through various old threads on here I get the impression that phenobarb may still be the best first choice treatment. What have anyone found?

[/quote]

We've got a few patients on it long-term as sole treatment with good results. For cases that present as typical idiopathic epilepsy I usually try it first as you don't get the lethargy and weight gain that you normally see with phenobarb, and there's no need for monitoring bloods. It also works much quicker, reaching steady state within a few days rather than weeks, so if the dog is having a lot of seizures you know quickly whether it's going to work or not, and if it doesn't you can go straight on to phenobarb.

RE: Pexion

Martin Atkinson — Wed, 14 Sep 2016 16:01:37 GMT

I have only tried it on one dog and it continued fitting at the same rate so I doubled the dose and its still made no difference. There has however been some change in its behaviour and her mother was PTS because of deteriorating neurological symptoms assumed to be a brain tumour. Blood tests all normal and they're reluctant to have further investigation. Bit of an arse of a client to be honest all they've done is complain about the cost and lack of response.

I was reluctant to add/change to phenobarb as she seemed lethargic and depressed already so was considering KBr but they haven't come back to me.

RE: Pexion

Gillian Mostyn — Wed, 14 Sep 2016 15:15:42 GMT

Not found it to be much use in the majority of the patients we've tried it on to be honest. I'd stick with pheno.

RE: Pexion

Bob Russell — Wed, 14 Sep 2016 15:03:45 GMT

Have a couple of patients on Pexion now. Mainly chosen because neither owner wanted to be bothered with a lot of monitoring!!!

One has done well, one is only doing well now I have added 'Keppra'. Not sure if it is the Pexion, Levetiracetam or the combination.