A desoxycorticosterone pivalate (DOCP) product was approved by the European Medicines Agency in 2015. Lower-than-label doses and extended treatment intervals have been reported by several authors. The frequency of use of DOCP as first-line mineralocorticoid supplementation, initial doses and treatment intervals have not been evaluated among Western European veterinary surgeons (WEVS). This study aimed to characterize the use of DOCP by WEVS in dogs diagnosed with Addison’s disease.

An online survey translated into four different languages (Portuguese, Spanish, French and Italian) was developed using an electronic platform. Respondents were recruited through social network veterinary groups and mailing lists. Questions focused on initial treatment regimen, DOCP starting dosage, clinical and electrolytic monitoring schedule in dogs diagnosed with Addison’s disease. Responses from participants who had diagnosed canine Addison’s disease over the previous 12 months were included.

Overall, 167 responses from six European countries were included (Portugal [n=65], Spain [n=55], Italy [n=34], France [n=8], Belgium [n=4] and Luxembourg [n=1]). Among respondents, 83% had already used DOCP and 78% indicated they preferred its use over fludrocortisone acetate as first-line treatment for mineralocorticoid supplementation. Among 138 respondents who had used DOCP, 61% indicated using 2.2 mg/kg as initial dosage while 15% stated using lower dosages. The remaining 24% did not detail it. Following initiation of DOCP treatment, 89% of respondents indicated monitoring electrolytes twice a month (67% at day 10 and day 25 and 22% at day 10 and day 28–30) and 11% once a month (6% at day 10, 3% at day 25 and 2% at day 28–30) until stabilization. Out of 89 WEVS that specified a preferable therapeutic adjustment, 51% indicated changing administration interval rather than dosage while 49% stated changing dosage rather than frequency. Following the initial administration, 9% of respondents indicated administering subsequent DOCP injections only in case of clinical relapse. In dogs with stable electrolytes concentrations, 34% of respondents reported reassessing dogs monthly, 44% quarterly, 17% twice yearly and 5% yearly.

In Western Europe, DOCP is the preferred treatment for mineralocorticoid supplementation. The large majority of WEVS follow the manufacturer’s recommendations for initial dosage and short-term monitoring schedule. Subsequent preferred therapeutic adjustments regarding change in dosage or dosing intervals vary among WEVS, most likely reflecting the absence of strict guidelines. Of particular concern, a significant proportion of WEVS only administer DOCP in case of clinical relapse following the initial administration, which likely increases the risk of addisonian crisis.

Disclosures

Disclosures to report
Dechra Veterinary Products (Iberia) Ltd did aid in the promotion of the questionnaire. Study funded by: Project UIDP/CVT/00276/2020 (funded by FCT).