Comparison of Heartworm Preventatives (re: Safety)

Okay - so having looked closer at the chart - I'm assuming that the numbers, as they relate to date of FDA approval, tell a clearer picture.  For example - Revolution has only been approved since 1999 vs. Heartguard which has been around since 1989.  BUT - I'm probably confusing myself (hopefully not anyone else), but wouldn't the numbers treated vs. the number of deaths, still be the only thing that's relevant? 

ORIGINAL: cakana but wouldn't the numbers treated vs. the number of deaths, still be the only thing that's relevant? 

 
Not IMO, it would worry me if Revolution has had an equal (or greater) number of deaths then a product that has been on the market for well over a decade (compared to them only being around for about 8 years)... 
 
I haven't had a close look at the chart though...I'll look close when I get home![]

Really?  So if "alpha" had been on the market 10 years, 100 people took and 10 died (death rate = 10%)  vs. "beta" had been on the market 4 years, 400 people took it and 30 died (death rate = .075%) the fact that one had been on the market longer would be the relevant factor? 
 
I'm honestly not trying to be argumentative - but because of jobs I've had, I know that data and statistics can be misconstrued.  My boss loves to analyze data, but he's out of town, so I'm just trying to figure it out myself.

the whole dog journal had an article about heartworm preventatives in the march issue. unless i read it wrong, the author of the article recommended heartguard and interceptor over all others. a daily prventative called DEC second and heartguard plus 3rd. she didnt really recommend using sentinel, and was "less enthusiastic about selamectin (found in Revolution)..." as she didnt really like the fact that it treated a broad spectrum of parasites not just heartworm.

she didnt really give any numbers like you found, but commented that heartguard and interceptor are "generally considered safe"

you have a point about the percentages, but i think that jetty is correct that you would want to compare the percentages over the same number of years. and possibly over the exact same range (ie 1990-1995 for instance) because there could be some overwhelming enviornmental factors swaying the percentages during those years. of course i am probably wrong.

not sure if this helps or not []

Hello there []

All major brands are reasonably safe, much safer than acquiring heartworm in any case. If you have encountered claims like "Revolution" (or any other heartworm medication) is the worst, horrible, most deadly - as you sound you did - be aware that they are most often more a product of hype (rapidly spread via the internet these days [] ) rather than knowledge.

Regarding your list, you should note that the date of release is inconsequential. What matters is the amount of controlled applications (treated) and the amount of dogs that died as a consequence. As a side note, that 'report' on that page being rather cryptical in general, I also pondered if 'treated' meant "treated for problems and reported to the FDA", but that would make little sense here in my view. Now, it also matters how exactly the medication was applied, when, in what setting, in what health the dogs were and so forth. Real clinical reports will detail that all ad nauseam, but information of that sort is extremely important to really assess the validity of a trial.

Getting back to your date, even if the date were to indicate the date and the reported numbers of incidences since release - as for instance were the case if 'treated' really stands for 'cases reported to the FDA', it still would have no value. What matters, then, is the number of treatments sold. A product can be on the market for 5 years and be outsold within a year or two by a new product, or two products might be on the market for the same time, but are sold in different amounts. Comparing those by date and 'cases reported' then, will make the more popular one look as being the worse one, even though in fact it might outperform and be safer than its rival.

Be that as it may, taking the numbers as clinical trials, your own list for instance rates Revolution as about two times safer (!!) than Interceptor (2.5% deaths for Revolution, 5.4% deaths for Interceptor). You see that these cannot have been standard applications of the medication, because I dare to say (I could search for some valid academic research if I must, but my time is limited) that Interceptor given in normal dosages to healthy dogs will not kill every 20th dog. Neither will Revolution.

The gist of the matter is this: use a major brand like Revolution, Proheart, Interceptor, or Sentinel and you will be reasonably safe - about as safe as you will be yourself if you had to take some serious medication every month. Every pain pill can kill. I am still a wimp and take them. []

All major brands are reasonably safe, much safer than acquiring heartworm in any case.

 
Normally I don't stress over stuff much and trust my vet, but having read the stories about ProHeart 6, I'm much more cautious.  I agree that I don't want my dog to get heartworm and had been using Heartguard.  The vet switched us to Revolution because she worries the allergies might be related (or worsened) by Heartguard.  I will probably use the Revolution for this summer and keep an eye open for any changes, but I just wanted to make sure I wasn't using something awful like ProHeart 6.

That chart is very confusing and for unknown reason, the FDA has not updated it in well over a year.  Use to be updated very often.  I know of other dogs who have died from the PH6 after battling as long as 2 years against siezures, gastric problems, etc.  But the figure was never changed.  It has been about 6 months since  I got my last e-mail of one dying  A 4 year old pittie who got his first PH6 when he had just turned 2. He went from a puppy to an old man --an autoimmune disease (not anemia like my Hunter).  Ozzy fought for 25 months, but died.  I was so sad when Kristen e-mailed to tell me just about a year ago.
 
Anway I am not sure what the firgures under TREATED means, but was told that in some cases more than one dog got PH6 at the same time and only one had a reaction.    Right in from of me I have Hunter's Evaluation, done by FDA vets, which i got from the FDA. The sad part is  based on information they got  the  from  report Fort Dodge sent them (I had agreed to let Hunter's records be sent by my vet to Fort Dodge).  It says Hunter's  Health Status was FAIR and that my vet's opionon of PH6 being responsible was  LOW.  It also left out some of the things, like his 9 pound weight loss, etc.  A couple of weeks ago my vet and I went over Hunter's record to double check and he had said Hunter's health was good--never been sick, only in for wellness, vax, pulled muscle in shoulder, injured front leg, and for removal of a small birthmark on his side that he made bleed a couple of times.Also, he had said his opinon was the chances were mid to high that PH6 caused Hunter's death.  So the FDA did not get the full, correct informaion to evaluate Hunter's death and still ruled it high possible.
 
But i am getting away from what I was going to say.  One the fiirst page it has all kinds of information--drub, date given, dosage, reason for giving, health status, vet opion, etc, etc, and then
 
# Treated        1
# Reacted        1
# Died              1
 
So since they clump those 3 things together in the  report, and Hunter was the only one of mine to get Proheart that day--it makes sense that the Treated number does mean that in cases more than one dog was treated,  and one or more had reactions, one or more didn't.
 
Since we can't know  how many doses of each has been given, the best we can do is check the date the FDA okay it, and then check the number of reactions and deaths. See, like Proheart was only one the market a 3 years and a few months, 600 dogs died.  Interceptor had been on the market something like 13 or so years, and 128 (I think) dogs had died.    My vet has mine on Interceptor.  He also carries Hartguard, but he does not carry revolution as several his clients dogs did come down with heartworms while on it.  I personally only know 2 people who use it, and they get it from vet in next county.    I do not know anyone who uses Sentinel.   With the exception of the two using Revolution--in fact only one uses.  The other finally had to put his 17 year old hound down about 8 months ago.---everyone uses either Hartguard or Interceptor.
 
I know it is confusing.  I do know that dogs  have died on every single one of them.  As my Mom would say, it is picking the lesser of two evils.  But there is a 3rd evil, heartworms and they will always kill 9if not treated, and the treametn can kill)  But anyway that is the best I can do to help you out.

I could be wrong (and that's highly likely), but the way that I've always interpreted that chart was that it reflected a running total of cases where a report has been made to the FDA where an adverse reaction (including deaths) is suspected to have been caused by the medication.  I've also always thought that the reason the "number treated" totals are slightly higher than the "reacted" totals is because there were probably some initial reports which were later determined that the "reaction/death" was not related to the medication. As Sandra said, it doesn't give you a total of how many dogs nationwide have received the different medications, it only gives stats on the number of animals that reacted and a report was filed.  So it's hard to get a clear picture...there could have been 10 times more prescriptions filled for one type than another.  However, I do think that how long a product has been on the market is important.  If, as is the case with ph6, there were 5473 reactions (including 599 deaths) reported on a product that had been on the market for less than 4 years compared to equal or fewer numbers for products that have been on the market for a much longer time, the assumption would be that particular drug is more dangerous to use.  

Thanks all - it just makes my head hurt to even think about what it means and I hate having to even use it.  Heartworm isn't a huge concern here in Northern Calif., but I don't want to be one of the unlucky ones.  I can't remember who it is, but someone on this board just gets heartworm testing done every 6 months and doesn't give any preventative.  I'm almost tempted to go that route - but spring is finally arriving here and I feel like I need to decide in the next few days.  I've already given my other dog her Heartguard, but Sassy has had so many problems (infections, allergies, etc.) I've postponed as long as I could.
 

This thing I got--I had to send off for this FOI report  and it is titled FDA/CVM-ADEReports-CVM Response.
 
From the information given they judge each sympton/sign and rate it.    It is scored as follows
-9   The drug was not used for labeled indication
-7 to -8  Information was lacking and or no conclusion could be made
-1 to -6   The sumpton or sign is remotely likelyt to be drug -related
0 to 2--The sympton or sign is possibly related to the drug
3 to 5  The sympton or sign is probably related to the drug
6 to 7  The symtpon or sign is defineklty relatd to the drug.
 
When misinformation is given, the evaluation can not be as accurate (tho none would ever be tootally acdurate I would think).  Like my vet told me he reported to Fort Dodge that Hunter was in good health prior to his AIHa, yet Fort Dodge reported to the FDA that Hunter was only in fair health.  My vet said he reported to the FDA that the likely hood of PH killing my hunter was mid to high, yet  they reporeted to the FDA that his opion was low.  They also failed to report his 9 pound weight loss.  Even so he was scored as high possible ON THE REPORT I GOT a couple of months ago.
 
Here is the kicker.  Jean took all 3 of hers in the same day.  In two months, one was dead of AIHA, another of liver, and the 3rd is on meds the rest of his life.   About a year ago a Fort dodge lawyer told her lawyer the scores were being redone and not in favor of the dog owners, and at least one of Jean's dogs had been rescored.  For the first time i decided to get a copy of Hunter's evaluation, but didn't get it done until late summer.  When I got it I saw they had scored Hunter a few low possible, some mid possible and several high possible.  But i remembered seeing a r eport that had been posted by one whose dog had gotten nearly all 4 (probably) including some of the ones Hunter had only gotten a 1 for. Her precious yorkie was like 11 or 12 and my Hunter had just turned 4. 
 
Well, long story short, she found out about the rescoring and ordered a new copy--had gotten the one a few months after her dog died and that is what she had posted long ago on [linkhttp://www.thepetguardian.com]www.thepetguardian.com[/link].    When the new one came in a few weeks ago, every single one of the scores had been lowered from 3's and 4's to mostly 1's.  So it appears Fort Dodge got them to rescore--despite the fact they had sent in information on cases trying to downplay the chances of it being PH6.

The gist of the matter is this: use a major brand like Revolution, Proheart, Interceptor, or Sentinel and you will be reasonably safe - about as safe as you will be yourself if you had to take some serious medication every month. Every pain pill can kill. I am still a wimp and take them.

Umm Danny...did you miss the part about Proheart6 being pulled from the market...by the FDA?

We KNOW without a doubt that proheart isn't SAFE...not always.  And we know this because of the heartwrenching stories that have been posted here.
 
I personally found that Revolution was a waste when it came to fleas and other parasites.  If you feel the need to USE revolution, be sure you have some Frontline on hand since you will most probably need it.

ORIGINAL: polymatheia

The gist of the matter is this: use a major brand like Revolution, Proheart, Interceptor, or Sentinel and you will be reasonably safe

You forgot Heartgard Plus on your list of what's safe.
And Proheart is not safe.

Hello Mini-Mom []

Let me clarify a few things: First off, Proheart was not " pulled from the market...by the FDA". As a matter of fact, in 2004 it was voluntarily withdrawn by the manufacturer on request by the FDA, which makes for a huge difference in legal and practical matters. Secondly, since that time there has been a thorough reevaluation of the drug, and it is deemed safe (as safe or safer as other products) by the vast majority of researchers in the field. The most comprehensive study (by L. Glickman/Purdue) could not find any increased risk when compared to two other major brands of heartworm preventatives. Many reports of Proheart6 related problems, for instance, could in no way be shown to be related to that medication. What seems to have happened, for instance, was that once the snowball got rolling, every conceivable problem that occured with a dog within a week or two of administering that medication, suddenly was thought and reported as possibly linked to it. Using that procedure, drinking water will seem dangerous. Third, proheart remains available - to the best of my knowledge - in every other country it had been available before, simply because there is no scientific evidence of any increased risk when compared to dogs taking 6 pill of another product versus the one proheart shot (actually, it is still widely used in livestock even within the US). That the FDA approves or disapproves of a medication has many reasons, some political, some legal, some scientific, and when compared to drug agencies of other first world western countries, it has one of the worst reputations regarding product safety evaluation - not by my estimation, but that of JAMA (again, for a multitude of reasons) - but that will take us way too far off course for this thread here.

Personally I use Sentinel. I included Proheart in this my list because I do not believe it unreasonably dangerous and because there are not merely US members on here (for US members it obviously does not apply anyhow). Hope that satisfies your curiosity. []