In dogs with type I immune-mediated polyarthritis (IMPA), is sole treatment with other immunosuppressive agents as effective as treatment with corticosteroids at reducing clinical signs?
Clinical bottom line
Category of research question
Number and type of study designs reviews
One pragmatic open-label randomised controlled clinical trial.
Strength of evidence
In the single randomised controlled clinical trial reviewed, 7/10 (70%) of dogs in both treatment groups (prednisone or cyclosporine), were reported to have shown resolution of owner-reported symptoms, clinical symptoms and improved locomotor scores and cytologic signs of disease at the end of the 90 day trial period. Of the remaining dogs, 2/3 cyclosporine treated dogs required change to prednisone, and 2/3 prednisone treated dogs required combination therapy to achieve clinical response.
There is insufficient evidence to support the use of alternative immunosuppressive agents in place of corticosteroids for the treatment of IMPA type I. Further controlled clinical trials are needed before a change to clinical practice can be considered.
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.
Archer, T.M., Boothe, D.M., Langston, V.C., Fellman, C.L., Lunsford, K.V. & Mackin, A.J. (2014). Oral Cyclosporine Treatment in Dogs: A Review of the Literature. Journal of Veterinary Internal Medicine. 28(1), 1–20. DOI: https://doi.org/10.1111/jvim.12265
Bennett, D. (1987). Immune-based non-erosive inflammatory joint disease of the dog. 3. Canine idiopathic polyarthritis. Journal of Small Animal Practice. 28(10), 909–928. DOI: https://doi.org/10.1111/j.1748-5827.1987.tb01316.x
Berg, R.I.M., Sykes, J.E., Kass, P.H. & Vernau, W. (2009). Effect of Repeated Arthrocentesis on Cytologic Analysis of Synovial Fluid in Dogs. Journal of Veterinary Internal Medicine. 23(4), 814–817. DOI: https://doi.org/10.1111/j.1939-1676.2009.0340.x
Colopy, S.A., Baker, T.A. & Muir, P. (2010). Efficacy of leflunomide for treatment of immune-mediated polyarthritis in dogs: 14 cases (2006–2008). Journal of the American Veterinary Medical Association. 236(3), 312–318. DOI: https://doi.org/10.2460/javma.236.3.312
Eom, N. Y., Lee, H. C., Jang, H. M. & Jung, D. I. (2015). A Case of Treatment of Idiopathic Immune-Mediated Polyarthritis in a Dog. Journal of Veterinary Clinics. 32(4), 366–369. DOI: https://doi.org/10.17555/jvc.2015.08.32.4.366
Gregory, C.R., Stewart, A., Sturges, B., DeManvelle, T., Cannon, A., Ortega, T., Harb, M. & Morris, R.E. (1998). Leflunomide effectively treats naturally occurring immune-mediated and inflammatory diseases of dogs that are unresponsive to conventional therapy. Transplantation Proceedings. 30(8), 4143–4148. DOI: https://doi.org/10.1016/S0041-1345(98)01373-6
Innes, J.F. (2012). Arthritis. In K.M.Tobias, & S.A. Johnston. eds., Veterinary Surgery: Small Animal. Missouri, MO: Saunders Elsevier: 1096–1106.
Itoh, T., Nishi, A., Ikeda, A., Mizunaga, Y., Fujimoto, S. & Shii, H. (2010). Clinical features and treatment results of immune-mediated polyarthritis in 16 dogs. Japanese Journal of Veterinary Anesthesia and Surgery. 41(1), 1–7. DOI: https://doi.org/10.2327/jvas.41.1
Jacques, D., Cauzinille, L., Bouvy, B. & Dupre, G. (2002). A Retrospective Study of 40 Dogs with Polyarthritis. Veterinary Surgery. 31(5), 428–434. DOI: https://doi.org/10.1053/jvet.2002.34665
Johnson, K.C. & Mackin, A. (2012). Canine Immune-Mediated Polyarthritis: Part 2: Diagnosis and Treatment. Journal of the American Animal Hospital Association. 48(2),71–82. DOI: https://doi.org/10.5326/JAAHA-MS-5756
Kohn, B. (2007). Canine immune-mediated polyarthritis. European Journal of Companion Animal Practice. 17(2), 119–24.
Kohn, B., Lubke, S., Schmidt, M.F.G. & Brunnberg, L. (2005). Idiopathic immune-mediated polyarthritis type I in dog: occurrence, clinical findings, laboratory results, therapy and outcome of 16 cases (1996–2000). 50(7), 415.
Mackin, A., Archer, T., Lunsford, K., Fellman, C. & Thomason, J. (2016). Treatment of immune-mediated polyarthritis in dogs. Journal of the American Veterinary Medical Association. 248(8), 876–877.
Perry, K.L. (2015). IMPA – part two: clinical signs, diagnosis and treatment. Vet Times. 1–17. [online]. Available from: https://www.vettimes.co.uk/app/uploads/wp-post-to-pdf-enhanced-cache/1/impa-part-two-clinical-signs-diagnosis-and-treatment.pdf [Accessed October 2020].
Rhoades, A.C., Vernau, W., Kass, P.H., Herrera, M.A. & Sykes, J.E. (2016). Comparison of the efficacy of prednisone and cyclosporine for treatment of dogs with primary immune-mediated polyarthritis. Journal of the American Veterinary Medical Association. 248(4), 395–404. DOI: https://doi.org/10.2460/javma.248.4.395
Schulz, K. F., Altman, D. G., Moher, D. & the CONSORT Group. (2010). CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Medicine. 8(18). DOI: https://doi.org/10.1186/1741-7015-8-18
Stull, J.W., Evason, M., Carr, A.P. & Waldner, C. (2008). Canine immune-mediated polyarthritis: clinical and laboratory findings in 83 cases in western Canada (1991–2001). The Canadian Veterinary Journal. 49(12), 1195–1203.
Viviano, K.R. (2013). Update on Immununosuppressive Therapies for Dogs and Cats. Veterinary Clinics of North America: Small Animal Practice. 43(5), 1149–1170. DOI: https://doi.org/10.1016/j.cvsm.2013.04.009
Whitley, N.T. & Day, M.J. (2011). Immunomodulatory drugs and their application to the management of canine immuneâ€mediated disease. Journal of Small Animal Practice. 52(2), 70–85. DOI: https://doi.org/10.1111/j.1748-5827.2011.01024.x
Wilson-Wamboldt, J. (2011). Type I idiopathic non-erosive immune-mediated polyarthritis in a mixed-breed dog. The Canadian Veterinary Journal. 52(2), 192–196.
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