Drugs for immune-mediated anaemia

Re: Drugs for immune-mediated anaemia

KMurphy — Tue, 28 Dec 2010 10:03:16 GMT

Sorry, I should have said! She recommended to cut the Pred to 0.5mg/kg, recheck haematology in two weeks and, if all is well, reduce cyclosporine to EOD. She did say that there were no fixed protocols so I think any of the suggestions would have been just as useful but I figured we should all stick to the same plan.

Re: Drugs for immune-mediated anaemia

Martin Atkinson — Fri, 24 Dec 2010 16:04:00 GMT

[quote user="KMurphy"]

The clinician also phoned yesterday to discuss the medication with me

[/quote]

OK don't keep us in suspense, what did she recommend so we can see if we were right?

Re: Drugs for immune-mediated anaemia

KMurphy — Fri, 24 Dec 2010 10:10:50 GMT

Quick update - Following my comments on here, I've just received an apologetic note from the referral centre explaining that there had been a problem with their internal communication so messages hadn't always reached the clinician. The clinician also phoned yesterday to discuss the medication with me so we're all on the same page again, which is good for everyone involved!!

Re: Drugs for immune-mediated anaemia

Mark Holmes — Thu, 23 Dec 2010 12:49:38 GMT

[quote user="KMurphy"]

Hope you all have a lovely Christmas - only 2 sleeps to go!

[/quote]

Actually three until its over..... here's waiting! Ba humbug

Re: Drugs for immune-mediated anaemia

Hannah Wynne Richards — Thu, 23 Dec 2010 12:26:52 GMT

Kate Which referral centre ? I think we all need to know, so we can avoid them

Wynne

Re: Drugs for immune-mediated anaemia

KMurphy — Thu, 23 Dec 2010 12:25:45 GMT

Thank you for all your replies.

The referral centre in question is not renowned for their communication skills but I was forced into using it due to the bad weather preventing travel further afield. The report did describe the drugs the dog was getting but didn't include any plan for continuing treatment as they had intended to see the dog back themselves. However, for practical and cost reasons the owner wanted to do the continuation treatment here.

The clinician did phone once when I was in the middle of consulting but wouldn't leave any message and didn't want to send an email. I tried to phone her back an hour later and she was unreachable again and since then we've heard nothing. I'm trying to be generous and hope that she's just not received my messages or she's extremely busy or both!

I've decided to reduce the cyclosporine to EOD for the next week and recheck haematology then. If it all stays stable then I'll likely stop this altogether and then reduce the other drugs. I'll keep my fingers crossed!

Hope you all have a lovely Christmas - only 2 sleeps to go!

Re: Drugs for immune-mediated anaemia

Rob Davis — Thu, 23 Dec 2010 10:25:21 GMT

[quote user="KMurphy"]I have tried to speak to the referral clinician for the past 3 days about this but she's always busy or just hasn't returned my calls, which is very frustrating!![/quote]

I would definitely not be using this referral centre again if at all possible! However busy she is, it would only take a couple of minutes to call you and discuss her plan (it should be HER plan as SHE started the treatment). Did you not get any instructions or report from the referral centre?

Re: Drugs for immune-mediated anaemia

Andrew Kent — Wed, 22 Dec 2010 16:24:21 GMT

I tend to use ciclosporin in cases where I have not got a response to pred within a few days and I need something quicker than azathioprine. Or I may start it at the outset in dogs that are very anaemic and I don't feel I have time on my side or they are showing evidence of intravascular haemolysis.

On the whole I use it for a fixed period of 3 weeks or so and then stop. I would then taper the azathioprine/pred.

Hope that helps,

Andy

Re: Drugs for immune-mediated anaemia

Martin Atkinson — Wed, 22 Dec 2010 16:02:32 GMT

[quote user="KMurphy"]

I have tried to speak to the referral clinician for the past 3 days about this but she's always busy or just hasn't returned my calls, which is very frustrating!! I'd really appreciate any advice if anybody has experience with this treatment combination!

[/quote]

I would phone the referral centre again.... and again and get shirty until she talks to you, it is downright discourteous and unprofessional for her not to return your calls as surely the patient is theoretically still under her care and you should maintain present doses as she is responsible for its wellbeing until she had given you instructions otherwise. Perhaps leave a message sugesting that it will be her VDS policy that will be claimed on if the dog goes belly-up.That notwithstanding, I would stop the cyclosporine and gradually taper first the azathioprine then the preds based on repeat blood counts to maintenance dose or until you can stop. Any ideas what invoked the AIHA? it could be a one-off reaction to vaccination or another drug or concurrent illness.

Re: Drugs for immune-mediated anaemia

KMurphy — Wed, 22 Dec 2010 15:07:10 GMT

Thanks for the quick replies - both have been very helpful!

I have treated AIHA before, just never the three drugs in combination and it's been one of those busy, busy weeks so far where I'm just catching up with myself now!

Have a great Christmas!

Re: Drugs for immune-mediated anaemia

Rach — Wed, 22 Dec 2010 14:55:21 GMT

I'm not sure if the link will work, but there was an article in Vet Times earlier this year that may help. http://www.vetsonline.com/Recherche/Resultat/a6b8066ae61d6a3db97114016d35f214/8

Re: Drugs for immune-mediated anaemia

Alex Allen — Wed, 22 Dec 2010 14:49:59 GMT

Have you tried calling the Tech advisors at Novartis? They would be able to give you advice re the ciclosporin. There are a few papers published on this subject - www.pubmed.gov

Novartis Animal Health UK Ltd

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