In cats with feline infectious peritonitis (FIP), does treatment with the nucleoside analogue GS-441524 or the protease inhibitor GC376, compared to supportive measures alone, lead to longer survival times?
Clinical bottom line
Category of research question
The number and type of study designs reviewed
Five studies, including four uncontrolled interventional studies and one case-series were critically reviewed
Strength of evidence
The reviewed studies collectively provide moderate evidence in support of the application of GS-441524 or GC376 to extend the survival time of cats suffering from feline infectious peritonitis
While these antiviral drugs are considered the most likely options for FIP treatment, more robust evidence should be obtained through well-designed randomised controlled trials to verify the observed positive effects in treating various forms of the disease and the potential long-term side effects. However, the ethical dilemmas of conducting double blinded placebo-controlled trials, which by necessity include untreated cats with an invariably fatal disease are recognised
How to apply this evidence in practice
The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
Dickinson, P. J., Bannasch, M., Thomasy, S. M., Murthy, V. D., Vernau, K. M., Liepnieks, M., Montgomery, E., Knickelbein, K. E., Murphy, B. & Pedersen, N. C. (2020). Antiviral treatment using the adenosine nucleoside analogue GS-441524 in cats with clinically diagnosed neurological feline infectious peritonitis. Journal of Veterinary Internal Medicine. 34(4), 1587–1593. DOI: https://doi.org/10.1111/jvim.15780
Izes, A. M., Yu J., Norris, J. M. & Govendir, M. (2020). Current status on treatment options for feline infectious peritonitis and SARS-CoV-2 positive cats. Veterinary Quarterly. 40(1), 322–330. DOI: https://doi.org/10.1080/01652176.2020.1845917
Kennedy, M. A. (2020). Feline Infectious Peritonitis: Update on Pathogenesis, Diagnostics, and Treatment. Veterinary Clinics of North America: Small Animal Practice. 50(5), 1001–1011. DOI: https://doi.org/10.1016/j.cvsm.2020.05.002
Kim, Y., Liu, H., Galasiti Kankanamalage, A. C., Weerasekara, S., Hua, D. H., Groutas, W. C., Chang, K-O. & Pedersen, N. C. (2016). Reversal of the Progression of Fatal Coronavirus Infection in Cats by a Broad-Spectrum Coronavirus Protease Inhibitor. PLoS Pathogens. 12(5), e1005531. DOI: https://doi.org/10.1371/journal.ppat.1005531
Murphy, B. G., Perron, M., Murakami, E., Bauer, K., Park, Y., Eckstrand, C., Liepnieks, M. & Pedersen, N. C. (2018). The nucleoside analog GS-441524 strongly inhibits feline infectious peritonitis (FIP) virus in tissue culture and experimental cat infection studies. Veterinary Microbiology. 219, 226–233. DOI: https://doi.org/10.1016/j.vetmic.2018.04.026
Pedersen, N. C., Kim, Y., Liu, H., Galasiti Kankanamalage, A. C., Eckstrand, C., Groutas, W. C., Bannasch, M., Meadows, J. M., & Chang, K-O. (2018). Efficacy of a 3C-like protease inhibitor in treating various forms of acquired feline infectious peritonitis. Journal of Feline Medicine and Surgery. 20(4), 378–392. DOI: https://doi.org/10.1177%2F1098612X17729626
Pedersen, N. C., Perron, M., Bannasch, M., Montgomery, E., Murakami, E., Liepnieks, M. & Liu, H. (2019). Efficacy and safety of the nucleoside analog GS-441524 for treatment of cats with naturally occurring feline infectious peritonitis. Journal of Feline Medicine and Surgery. 21(4), 271–281. DOI: https://doi.org/10.1177%2F1098612X19825701
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