Weaning From Steroids and Atopica

[lbacon]

I have a question about long term use of Predisone and Atopica. We have a 2 year old beagle . Weights about 16 pounds. Approx. 6 months ago she experienced a sudden onset febrile illnesses and became gravely ill. Our local vet sent her immediately to our University Vet Hospital. She was in ICU for a week with a very poor prognosis. It was felt this was either a primary or secondary autoimmune illness. A bone marrow R/O a primary illness. Titers for tick born illnesses were also inconclusive and/or negative. She was treated with multiple antibiotics, steroids and ultimatley with a platelet transfusion. She did stabloize enought to go home after approx a week on predinose 20mg daily and Atopica 50mg BID and antibiotics. Over the past six months she completed the inital round of antibiotics after about a month. We are now doing a very slow wean of the prednisone. Now after about 6 months, she is on 2.5mg of prednisone every other day and atopica 50mg bid. She has had CBC regularly (first weekly, but now every 4-5 weeks). All CBCs have been normal. While on higher doses of course she was drinking and urinating lots and she did gain weight a bit. Now she seems back to her base line. She eats well, is very active and doesn't have any digestive, urinary or skin problems...actually no apparent side effects or problems at all. We are concerned that she has been on these meds for so long. I would like to ask what an appropriate dosage /schedule would be to wean off Atopica. What are the potential side effects/problems for a more rapid wean off the Atopica? We also wanted advice as to how long we should keep her away from the dog park and also when to restart her routine vaccinations? We have been protective of her being around other animals due to her questionable immune status. Any and all advise would be so helpful. Thanks so much.

[Dr Lee]

I am glad that your pet is doing so well.

While we always worry about long term effects from immunosuppressive medications, tapering them too quickly in the fact of a serious autoimmune disorder can be far worse! It is important to remember than when pets with primary autoimmune disorders (such things as IMHA/AIHA, ITP, etc..) have relapses, the relapses are usually WORSE than the original symptoms and can be HARDER to control a second time. So bottom line, we should taper slowly (which it sounds like you and your vet are doing).

Atopica is a microemulsified form of cyclosporine in castor oil. It is far safer than other forms of cyclosporine and works better due to the microemulsification. It should NOT be given with food. There are many pets (such as those with allergies) that are on this lifelong. In general, I prefer this over steroids use (if we have to use something). As the capsule is a liquid, it cannot be split up. Thus tapering the dose can be challenging.

There are multiple sizes with Atopica. So when tapering, it can be done using a combination of changing both size and dosing frequency. Typically, the dose is reduced in 20% or so increments over long periods of time. Your veterinarian should really work this out for you. As I don't know what the exact disease is, your pet thus far has been doing well and your vet has already been having you taper down - I would continue to follow your vet's advice. We don't want to rock the boat at this point!

It is also important to remember that there are some autoimmune disorders and some pets that can never fully come off of immunosuppressive medications. Whether it should be the pred or the Atopica or a combination, should be up to you and your vet.

It is hard to give you an exact answer on the vaccinations but there is a good chance that your pet should not ever have additional vaccinations. Vaccine blood titers can help establish immunity against certain diseases and while the tests are not perfect - nor are vaccines! ...and in your pet's condition, these blood tests may be a whole lot safer. If you have to get vaccines, I would talk to your vet about which ones, use of recombinant vaccines and whether steroids need to be given at the time or not. I had a patient that required rabies vaccinations for legal reasons, upon consulting with an internal medicine specialist -we took pre-vaccination CBC test, injected dexamethasone intravenously twenty minutes prior to vaccination, we increased oral steroids for a short while and rechecked three additional CBC tests at 48 hrs, 2 weeks and a month. The internal medicine specialist was also of the same mind that for that pet, no further vaccinations should ever be given on the risk of retriggering the autoimmune disease.

Again, I cannot answer your questions as I do not know the exact autoimmune disease your pet has nor am I familiar with the case but I hope that this has explained some helpful items for you,.


Best of luck