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Comparison of a chlorambucil-prednisolone combination with an azathioprine-prednisolone combination for treatment of chronic enteropathy with concurrent protein-losing enteropathy in dogs: 27 cases (2007–2010)

Julien R. S. Dandrieux Dr med vet, DACVIM1, Peter-John M. Noble BVM&S, PhD2, Timothy J. Scase BVM&S, PhD, DACVP3, Peter J. Cripps BVSC, PhD4, and Alexander J. German BVSC, PhD5
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  • 1 School of Veterinary Science, University of Liverpool, Neston CH64 7TE, England.
  • | 2 School of Veterinary Science, University of Liverpool, Neston CH64 7TE, England.
  • | 3 Bridge Pathology Ltd, PO Box 2877, Bristol, BS8 9FH, England.
  • | 4 School of Veterinary Science, University of Liverpool, Neston CH64 7TE, England.
  • | 5 School of Veterinary Science, University of Liverpool, Neston CH64 7TE, England.

Abstract

Objective—To compare treatment protocols for chronic enteropathy and concurrent protein-losing enteropathy that used prednisolone in conjunction with either azathioprine or chlorambucil in dogs.

Design—Retrospective case series.

Animals—27 dogs.

Procedures—All dogs had hypoalbuminemia (serum albumin concentration, < 18.0 g/L) and chronic enteropathy as diagnosed via complete gastrointestinal tract investigations including intestinal biopsy. Dogs received either an azathioprine-prednisolone combination (group A; n = 13) or a chlorambucil-prednisolone combination (group C; 14). Response to treatment was assessed by evaluation of body weight gain, serum albumin concentration, and duration of primary treatment.

Results—No significant pretreatment differences were detected between groups for any baseline variable (signalment and weight), clinicopathologic variable (albumin, cobalamin, and folate concentrations), or histopathologic findings. After treatment, serum albumin concentration and weight gain were significantly greater in group C. Median survival time for group A dogs was 30 days (95% confidence interval, 15 to 45 days) and was not reached for group C dogs. Duration of primary treatment was positively associated with the histopathologic presence of mild lacteal dilatation and use of a chlorambucil-prednisolone combination.

Conclusions and Clinical Relevance—Results suggested that a chlorambucil-prednisolone protocol is more efficacious for treatment of chronic enteropathy and concurrent protein-losing enteropathy, compared with an azathioprine-prednisolone combination. Given these findings, a prospective randomized clinical trial is warranted.

Abstract

Objective—To compare treatment protocols for chronic enteropathy and concurrent protein-losing enteropathy that used prednisolone in conjunction with either azathioprine or chlorambucil in dogs.

Design—Retrospective case series.

Animals—27 dogs.

Procedures—All dogs had hypoalbuminemia (serum albumin concentration, < 18.0 g/L) and chronic enteropathy as diagnosed via complete gastrointestinal tract investigations including intestinal biopsy. Dogs received either an azathioprine-prednisolone combination (group A; n = 13) or a chlorambucil-prednisolone combination (group C; 14). Response to treatment was assessed by evaluation of body weight gain, serum albumin concentration, and duration of primary treatment.

Results—No significant pretreatment differences were detected between groups for any baseline variable (signalment and weight), clinicopathologic variable (albumin, cobalamin, and folate concentrations), or histopathologic findings. After treatment, serum albumin concentration and weight gain were significantly greater in group C. Median survival time for group A dogs was 30 days (95% confidence interval, 15 to 45 days) and was not reached for group C dogs. Duration of primary treatment was positively associated with the histopathologic presence of mild lacteal dilatation and use of a chlorambucil-prednisolone combination.

Conclusions and Clinical Relevance—Results suggested that a chlorambucil-prednisolone protocol is more efficacious for treatment of chronic enteropathy and concurrent protein-losing enteropathy, compared with an azathioprine-prednisolone combination. Given these findings, a prospective randomized clinical trial is warranted.

Contributor Notes

Dr. Dandrieux's present address is University of Melbourne, Werribee, VIC 3030, Australia. The work was performed at the School of Veterinary Science, University of Liverpool, Neston, England.

Dr. German's senior lectureship was funded by Royal Canin.

Presented in abstract form at the 21st European College of Veterinary Internal Medicine Annual Congress, Seville, Spain, September 2011.

Address correspondence to Dr. Dandrieux (jdandrieux@gmail.com).