ABSTRACT OF THE WEEK

Journal of veterinary internal medicine/ American College of Veterinary Internal Medicine
Volume 38 | Issue 4 (2024 Jul-Aug)

Prospective randomized trial comparing relapse rates in dogs with steroid-responsive meningitis-arteritis treated with a 6-week or 6-month prednisolone protocol.

J Vet Intern Med. 2024 Jul-Aug;38(4):2221 - 2227.

Jeremy H Rose¹, Colin J Driver², Lorna Arrol³, Thomas J A Cardy⁴, Joana Tabanez⁵, Anna Tauro⁶, Ricardo Fernandes⁷, Imogen Schofield⁸, Sophie Adamantos⁹, Nicolas Granger¹⁰, Thomas R Harcourt-Brown¹¹

¹ Lumbry Park Veterinary Specialists, CVS Group plc, Alton, United Kingdom.; ² Lumbry Park Veterinary Specialists, CVS Group plc, Alton, United Kingdom.; ³ Lumbry Park Veterinary Specialists, CVS Group plc, Alton, United Kingdom.; ⁴ Cave Veterinary Specialists, Linnaeus group, Wellington, United Kingdom.; ⁵ Lumbry Park Veterinary Specialists, CVS Group plc, Alton, United Kingdom.; ⁶ College of Veterinary Medicine, North Carolina State University, Raleigh, USA.; ⁷ Blaise Referrals, IVC Evidensia Referrals, Birmingham, United Kingdom.; ⁸ CVS Group plc, Diss, United Kingdom.; ⁹ Paragon Veterinary Referrals, Linnaeus group, Wakefield, United Kingdom.; ¹⁰ Bristol Vet Specialists, CVS Group plc, Bristol, United Kingdom.; ¹¹ Langford Small Animal Hospital, Bristol Veterinary School, University of Bristol, Bristol, United Kingdom.

Abstract

BACKGROUND:Traditionally, 6-month courses of prednisolone are used to treat steroid-responsive meningitis-arteritis (SRMA), but this medication is associated with adverse effects that can lead to poor quality of life.

HYPOTHESIS/OBJECTIVES:Resolution of clinical signs and rate of relapse of SRMA would not be significantly different between a 6-month prednisolone protocol and a 6-week protocol.

ANIMALS:Forty-four hospital cases from multiple referral centers in the United Kingdom (2015-2019). Twenty of 44 were treated with the 6-month protocol and 24/44 with the 6-week protocol.

METHODS:Prospective, randomized trial with 12-month follow-up. The same prednisolone protocol reinitiated in the event of relapse. Analysis of relapses with binary logistic and Poisson regression modeling.

RESULTS:All cases responded to their treatment protocol. Relapses occurred in 6/20 (30%) of the 6-month protocol and 9/24 (38%) of the 6-week protocol. There was no statistical difference in the incidence risk of at least 1 relapse between the 2 groups (odds ratio = 1.40; 95% confidence interval [CI], 0.40-4.96, P = 0.60). Among the 15 dogs that relapsed, 10/15 (67%) relapsed once, 3/15 (20%) relapsed twice, and 2/15 (13%) relapsed 3 times. No statistical difference was detected in the incidence rate ratio (IRR) of total relapse events between the 2 groups (IRR = 1.46; 95% CI, 0.61-3.48; P = 0.40).

CONCLUSIONS AND CLINICAL IMPORTANCE:"Short" 6-week prednisolone protocols could be used to treat SRMA, thereby presumably reducing the duration and severity of prednisolone's adverse effects.

Keywords

PUO; aseptic meningitis; immune‐mediated; immunosuppression; neck pain; necrotising vasculitis; pyrexia of unknown origin;

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