ArticleJournal of feline medicine and surgery
High-dose induction therapy and treatment termination criteria for feline infectious peritonitis with remdesivir and GS-441524.
Article in Journal of feline medicine and surgery. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
ObjectivesFeline infectious peritonitis (FIP) can be treated with antiviral agents such as remdesivir and GS-441524, with a commonly used treatment duration of 12 weeks. Although serum amyloid A (SAA) and alpha-1 acid glycoprotein (α1AG) have been proposed as markers of disease improvement, the criteria for treatment cessation before this duration remain unclear. This study evaluated whether SAA and α1AG could guide treatment cessation in cats with FIP and whether a high-dose induction protocol could allow treatment duration to be shortened.MethodsA total of 30 cats with FIP, excluding those presenting solely with neurological signs, received high-dose (⩾20 mg/kg) therapy using injectable remdesivir followed by oral GS-441524 or oral GS-441524 alone. Remdesivir was administered once daily, whereas GS-441524 was given as the total daily dose divided into two doses 12 h apart. After initial improvement, the dose was reduced to the maintenance dose of 12-15 mg/kg based on clinical signs. Clinical signs, SAA and α1AG were monitored. Treatment was discontinued when clinical signs resolved and both SAA below 6 mg/l and α1AG 0.5 g/l or below were maintained for at least 2 consecutive weeks before 12 weeks or at 12 weeks regardless of these criteria.ResultsOf the 30 cats, 29 (96.7%) survived. Among these, 22 (75.9%) met the treatment termination criteria within 12 weeks (median treatment duration 54 days [range 41-71]), whereas seven completed 12 weeks. No relapse was observed during treatment or within the 3-month follow-up period.Conclusions and relevanceAlthough high-dose induction therapy is not a standard protocol, no clear adverse effects were observed, and treatment could be discontinued before 12 weeks in some cats. In cats with shortened treatment duration, improvement in SAA and α1AG concentrations appeared to be useful indicators for guiding treatment cessation. Further studies are required to clarify the clinical benefit of high-dose induction therapy.
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