Immune Suppressive Protocols

Immunosuppressive Protocols in the Dog

Usually – Prednisolone + Imuran (Azathioprine) + Gastroprotectants

Oral Prednisolone (usually used in combination with Azathioprine)

Two referenced protocols – both will work well but it always depends on how the dog is
improving, and coping with the drugs.

Ref: Clinical Immunology of the Dog & Cat by Michael J Day – Professor of Veterinary Pathology, University of Bristol, UK and WSAVA – Chairman of Scientific Advisory Committee.

This example is base on a dog receiving an induction dose of 1.0mg/kg/q12hrs

Dose Duration (based on clinical effect)

1.0mg/kg/q12h 10-28 days
0.75mg/kg/q12h 10-28 days
0.5mg/kg/q12h 10-28 days
0.25mg/kg/q12h 10-28 days
0.25mg/kg/q24h 10-28 days
0.25-0.5mg/kg/ Every other day at least 21 days
0.25-0.5 mg/kg/ Every third day at least 21 days

Ref: Canine Medicine and Therapeutics by Neil Gorman

1-2mg/kg/q12hrs for 10-28 days (starting at the lowest immunosuppressive dose)

Assuming clinical signs and blood results are good, and there is no evidence of immune destruction
on the blood smear etc., and the dog is coping with the side effects of the drugs,
the dose can be reduced by up to 50%.

This dose is given for another 10-21 days when the dose is reduced again by up to
50%. This is given for another 10-21 days.

This dose is given for another 10-21 days when the dose is reduced again by up to
50%. This is given for another 10-21 days.
This dose is given for another 10-21 days when the dose is reduced again by up to
50%. This is given for another 10-21 days.

For the next reduction the dose remains the same but given every other day. The
EOD dosing is reduced by up to 50% every month or so until the dose is so low a
decision can be made to keep the dog on this low maintenance dose or withdraw
altogether. Every reduction is made after consideration to clinical signs and
blood results.

 

Azathioprine (Imuran)

Azathioprine (a cytotoxic drug)  – otherwise known as Imuran – can be used in combination with prednisolone at 2mg/kg/24 or 48 hrs and dose gradually reduced, when remission is achieved, over a period of months.

Ref: Canine Medicine and Therapeutics by Neil Gorman

1-2mg/kg/q12hrs for 10-28 days (starting at the lowest immunosuppressive dose)

Assuming clinical signs and blood results are good, and there is no evidence of immune destruction
on the blood smear etc., and the dog is coping with the side effects of the drugs,
the dose can be reduced by up to 50%.

This dose is given for another 10-21 days when the dose is reduced again by up to
50%. This is given for another 10-21 days.

This dose is given for another 10-21 days when the dose is reduced again by up to
50%. This is given for another 10-21 days.
This dose is given for another 10-21 days when the dose is reduced again by up to
50%. This is given for another 10-21 days.

For the next reduction the dose remains the same but given every other day. The
EOD dosing is reduced by up to 50% every month or so until the dose is so low a
decision can be made to keep the dog on this low maintenance dose or withdraw
altogether. Every reduction is made after consideration to clinical signs and
blood results.

Don’t forget the Gastroprotectants!

A note from Jo Tucker (CIMDA)

Before cyclosporin was licensed for dogs with atopic skin disease, for many years the combination drugs of choice for immunosuppression were prednisolone and Azathioprine. This combination works very well for most dogs – there is always the exception though. All drugs carry different side effects and even though Aza can suppress bone marrow production it is rarely a problem. The combination of pred and Cyclosporin is being used more frequently now, I believe, because cyclosporin is now licensed. It is very, very expensive. Personally, I have known more dogs able to tolerate aza than cyclosporin and if I had to chose I would go for Pred and Aza. I am not keen on the long term side effects of cyclosporin (albeit human studies) but this is only my personal preference (because there is a choice) influenced by information I have read. Having said that, cyclosporin and pred works well for some dogs.

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