Prednisone, probiotics, and omeprazole...

Hello, Summarians!

Thanks for all your support. Lots of conflicting info about pred and GI protectants. Here is one study’s take…

Please give me feedback on ways I can make it more useful to you.

If it is valuable to you please consider sending it on to a friend 😄 

Feline diabetes survey

Diabetes mellitus (DM) is a common chronic endocrine disease in cats that can significantly impact the quality of life (QoL) for both the cat and its owner. The study found that feeding a cat a carbohydrate-aware (CA) wet diet was associated with higher remission rates and better QoL for the cat. Achieving remission is essential for improving the cat's QoL, and further studies are needed to investigate factors related to diabetic remission. 

A considerable number of cats (10-17%) were euthanized within a few weeks of diagnosis, but 63% of cats with DM survived for more than a year, and 25% survived for more than three years. The owner's concerns about the cat's life limitations and medication worries were negatively associated with the cat's survival time. Recognizing and managing owner distress is crucial for successful DM management and improving welfare for both the cat and its owner. 

Rothlin-Zachrisson, N, Öhlund, M, Röcklinsberg, H, Ström Holst, B. Survival, remission, and quality of life in diabetic cats. J Vet Intern Med. 2023; 37( 1): 58- 69. doi:10.1111/jvim.16625 

Bottom line - nice stats to share with newly diagnosed DM owners.

Prednisone, probiotics, omeprazole

Glucocorticoids are commonly used in human and veterinary medicine but can cause gastrointestinal bleeding. Dogs administered immunosuppressive doses of prednisone once daily for 28 days develop subclinical gastric bleeding and ulceration. Gastrointestinal bleeding increases the risks of thromboembolism and death in humans. Neither the incidence nor severity of gastrointestinal bleeding secondary to glucocorticoid therapy is mitigated by administration of misoprostol, sucralfate, cimetidine, or omeprazole. However, probiotics and synbiotics reduce hyperacidity-, ethanol-, and stress-induced gastric ulceration by increasing prostaglandin and mucus production, decreasing oxidative stress, and decreasing inflammatory cytokine production. In this randomized-controlled double-blinded study on dogs, the use of probiotics for mitigation of steroid-induced hemorrhage was not effective. However, omeprazole use showed a palliative effect on steroid-induced gastric bleeding, but dogs receiving omeprazole had more instances of diarrhea, and omeprazole use is associated with dysbiosis. Further evaluation of gastrointestinal bleeding in dogs with naturally occurring disease is warranted before recommending omeprazole use to prevent steroid-induced bleeding. 

Rak, MB, Moyers, TD, Price, JM, Whittemore, JC. Clinicopathologic and gastrointestinal effects of administration of prednisone, prednisone with omeprazole, or prednisone with probiotics to dogs: A double-blind randomized trial. J Vet Intern Med. 2023; 37( 2): 465- 475. doi:10.1111/jvim.16672 

Bottom line — Probiotics — no effect. Omeprazole decreases bleeding and increases GI signs - Dysbiosis ???

Retrospective IMHA Treatment protocols

Immune-mediated hemolytic anemia (na-IMHA) is a common immune-mediated disorder seen in dogs, which is managed with immunosuppressive and antithrombotic therapy. There is little evidence-based consensus among veterinarians regarding optimal treatment strategies, leading to variability in the use of glucocorticoids and second immunosuppressive agents, as well as anticoagulants versus antiplatelet drugs. A retrospective study compared the use of corticosteroids alone versus multi-agent immunosuppressive protocols, as well as clopidogrel alone versus a combination antithrombotic protocol for thrombus prevention in dogs with na-IMHA. The study found no significant differences in time to packed cell volume stabilization, duration of hospitalization, or case fatality rates between single-agent and multi-agent immunosuppressive protocols. However, dogs treated with single-agent immunosuppressive therapy had an increased rate of disease relapse compared to dogs treated with multi-agent immunosuppressive therapy. The study also found no significant differences in the development of thrombus formation between antiplatelet and anticoagulant drug protocols, although a combination protocol targeting both primary and secondary hemostasis was associated with a lower risk of definitive and suspected thrombus formation. The retrospective nature of the study and the lack of standardization in treatment and follow-up are limitations that should be considered when interpreting the results. 

Weng, J, Levy, NA, Abbott, HY, et al. Retrospective analysis of immunosuppressive and anti-thrombotic protocols in nonassociative immune mediated hemolytic anemia in dogs. J Vet Intern Med. 2023; 37( 2): 528- 536. doi:10.1111/jvim.16652 

Bottom line — Multiagent protocols may decrease relapses.

Just putting things in perspective …