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Mycophenolate mofetil treatment in dogs with serologically diagnosed acquired myasthenia gravis: 27 cases (1999–2008)

Curtis W. Dewey DVM, MS, DACVIM, DACVS1, Sofia Cerda-Gonzalez DVM, DACVIM2, Daniel J. Fletcher DVM, PhD, DACVECC3, Marcella F. Harb-Hauser DVM, DACVIM4, Jonathan M. Levine DVM, DACVIM5, Britton L. Badgley6, Natasha J. Olby VetMB, PhD, DACVIM7, and G. Diane Shelton DVM, PhD, DACVIM8
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  • 1 Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853
  • | 2 Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853
  • | 3 Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853
  • | 4 Pet Emergency and Specialty Center of Marin, 901 E San Francisco Blvd, San Rafael, CA 94901
  • | 5 Department of Veterinary Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843
  • | 6 Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853
  • | 7 Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606
  • | 8 Department of Pathology, School of Medicine, University of California-San Diego, La Jolla, CA 92093

Abstract

Objective—To compare clinical outcome in dogs with serologically diagnosed acquired myasthenia gravis (MG) treated with pyridostigmine bromide (PYR) with that of dogs treated with mycophenolate mofetil (MMF) and PYR (MMF + PYR).

Design—Retrospective case series.

Animals—27 dogs.

Procedures—Medical records from August 1999 through February 2008 were reviewed to identify dogs with serologically diagnosed acquired MG treated with PYR or MMF + PYR. Data collected for each dog included signalment, whether the dog had megaesophagus or pneumonia (or both), thyroid hormone concentration, remission, time to remission, and survival time. Rates for detection of clinical signs and survival time were compared. Survival time was estimated via the Kaplan-Meier method. Influence of drug treatment protocol on likelihood of remission, time to remission, and survival time was examined. Effects of MMF treatment, megaesophagus, pneumonia, and low serum thyroid hormone concentration on time to remission and survival time were also analyzed.

Results—12 dogs were treated with PYR, and 15 were treated with MMF + PYR. Mortality rates were 33% (PYR) and 40% (MMF + PYR). There was pharmacological remission in 5 and 6 dogs in the PYR and MMF + PYR groups, respectively. No significant differences were detected between treatment groups for remission rate, time to remission, or survival time. Megaesophagus, pneumonia, and low serum thyroid hormone concentration had no significant effect on time to remission or survival time for either treatment group.

Conclusions and Clinical Relevance—The results did not support routine use of MMF for the treatment of dogs with acquired MG.

Contributor Notes

Presented in abstract form at the 26th Annual American College of Veterinary Internal Medicine Forum, San Antonio, Tex, June 2008.

Address correspondence to Dr. Dewey (cwd27@cornell.edu).