IMHA: Comparision of azathioprine + prednisolone protocols with pred only

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IMHA: Comparision of azathioprine + prednisolone protocols with pred only

Posted : 5/24/2011 2:35:27 PM

For those unfamiliar with science journalese, this study compares prednisolone AND azathiprine to those treated with prednisolone only. Both are commonly used to treat IMHA. This study found no difference. The full paper is free at the link below.

http://www.biomedcentral.com/1746-6148/7/15

Lack of evidence of a beneficial effect of azathioprine in dogs treated with prednisolone for idiopathic immune-mediated hemolytic anemia: a retrospective cohort study

Christine J Piek¹ , Willem Evert van Spil¹ , Greet Junius² and Aldo Dekker³

¹Department of Clinical Sciences of Companion Animals, Utrecht, Utrecht University, PO Box 80154, 3508 TD Utrecht, The Netherlands

²Dierenkliniek Randstad, Frans Beirenslaan 155, 2150 Borsbeek, Belgium

³Central Institute for Animal Disease Control, P.O. Box 2004, 8203 AA Lelystad, The Netherlands

author email corresponding author email

BMC Veterinary Research 2011, 7:15doi:10.1186/1746-6148-7-15

The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1746-6148/7/15

Received:	7 October 2010
Accepted:	13 April 2011
Published:	13 April 2011

© 2011 Piek et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Azathioprine is used as an immunosuppressant in canine immune-mediated hemolytic anemia (IMHA), but this potentially toxic and carcinogenic drug has not been proven to be beneficial. The aim of this study was to determine the difference in outcome and survival of dogs with idiopathic IMHA treated with a protocol that included azathioprine and prednisolone versus a protocol that included prednisolone alone.

Results

The study included 222 dogs with a hematocrit lower than 0.30 L/L and either a positive Coombs' test or spherocytosis and no evidence of diseases that could trigger IMHA. The clinical and laboratory data at the time of diagnosis and the response to therapy and survival were compared in dogs treated according to the prednisolone and azathioprine protocol (AP protocol; n = 149) and dogs treated according to the prednisolone protocol (P protocol; n = 73). At study entry, the two groups were comparable, except that thrombocyte counts were significantly lower and clinical signs had been present significantly longer in the AP protocol group. No significant difference in survival was found between the two groups: the 1-year survival was 64% (95% CI 54 - 77%) in the P protocol group and 69% (95% CI 59-80%) in the AP protocol group, respectively.

Conclusions

Azathioprine would appear not to be beneficial as standard treatment for all cases of IMHA; however, a blinded, randomized clinical trial is needed to establish whether outcome is different with the two treatment protocols.

calliecritturs

Posted : 5/24/2011 3:33:14 PM

you can "study" but honestly you can't even begin to just spew forth numbers in this. Azathiaprene is pretty well just as bad (or worse) than pred as far as what it does to the liver. And these studies are done without trying to protect the liver in any way.

Aza (Imuran) is typically not the drug of choice anyway -- cyclosporine tends to target more specifically on the imune system "cascade" to nail the immunospressant in the proper place to get best results.

All the drugs have huge side effects. Most of the time (in the five years I've personally been tracking this and have seen the 3 years of the IMHA threads results -- not a "test" but surely a good source for seeing what's being done, what does and doesn't work, and the typical problems seen) when vets try to do *just* pred or even just pred & azathiaprene you wind up with huge spiked liver values. The problem becomes the dog surviving the liver damage until the immune system knuckles under.

Then they try to take the dog OFF the pred and/or azathiaprene so fast (to avoid the damage) that relapse occurs.

I know vets are trying to view "studies" but in honesty, particularly with IMHA the big deal is doing enough bloodwork and urinalysis to monitor **THAT** dog's response and needs. Just doing X mg/b.i.d. is dangerous. You really have to tailor each protocol to the particular patient and do what works in **that** particular case.

I tend not to be a study lover ... not at all. Research is definitely needed, but I wish the study had included cyclosporine because it's so well established that both pred and azathiaprene are SO hard on the liver. Again and again -- both on the long-running thread (as I said, it's no study but it so typically demonstrates what's happening out there) you see the vets who try to use only pred and azathiaprene run afoul of liver problems.

For whatever it's worth to the casual reader -- one of the reasons vets use pred and azathiaprene instead of cyclosporine is pure cost. IMHA is a viciously expensive disease to treat (particularly if the dog has required any transfusions), and cyclosporine is hugely expensive (even in the "generic modified" version which is somewhat cheaper than the dog name brand "Atopica";). Pred & azathiaprene are a mere fraction of the cost of cyclo. And ...fwiw, the cost of even the name brand Atopica is now far less than it was 5 years ago when Billy was on it. At that time, when we first brought him home from the vet school in Gainesville, his Atopica (30 pound dog) was the same price (within a few dollars) of my house payment a month. About $550. So it's no wonder vets are trying to use the less expensive drugs. If people can't afford the drug they can't treat the disease.