RESEARCH COMMUNICATIONS OF THE 28th ECVIM-CA CONGRESS

It is commonly accepted that dogs suffering from Inflammatory Bowel Disease (IBD) with protein‐losing enteropathy (PLE) need more aggressive immunosuppressive treatment than dogs with IBD but no PLE. At our hospital, treatment of PLE‐IBD follows a step‐wise algorithm to assess response to diet, antibiotics & prednisolone first, with second‐line immunosuppressants (SLI) only added if initial response is not satisfactory. It was hypothesised that results from this approach will challenge the need for SLI in many cases. Files of dogs diagnosed with PLE from 2015 to 2017 (n=68) were retrospectively analysed. Exclusion criteria were lack of initial serum albumin (SA) value (n=5), lack of histopathological diagnosis (n=9), diagnosis not compatible with IBD (intestinal lymphoma n=3, intestinal adenocarcinoma n=2, intussusception n=3, granulomatous colitis n=2, nutritional deficit n=1), significant intestinal bleeding contributing to protein loss (n=1), and significant concurrent disease (PLN n=1, endocrinopathies n=2, EPI n=1). In the remaining 38 dogs (15 FN, 14 MN, 6 ME, 3 FE; mean age of 7 y, sd 2.5), initial mean SA was 19.8g/l (sd 4.5) with the lowest recorded SA after diagnosis 17.7g/l mean (sd 4.7). 17/38 dogs had concurrent hypoglobulinaemia, 24/37 hypocholesterolaemia, 36/38 total and 5/31 ionised hypocalcaemia, 18/38 total hypomagnesaemia. Serum cobalamin was low in 21/36 dogs (58%). According to the treatment algorithm, 2 dogs (5%) were treated with diet alone, 5 dogs (13%) with diet + antibiotics, 17 dogs (44%) with diet, antibiotics and prednisolone. 14 dogs (36%) subsequently needed SLI, which in 10/14 cases was cyclosporine and 4 dogs receiving another SLI (cyclophosphamide, mycophenolate, chlorambucil). Overall time until SA rose above 20g/l was median 11 days (range 0‐136 days) and median follow‐up time was 79 days (range 4‐463 days). 8 dogs were deceased by the end of the study (21%). There was no difference between dogs with and without SLI regarding clinicopathological data (t‐tests, Kruskal Wallis tests). No correlation between these variables, treatment requirements, time to normalisation of SA or outcome could be detected. In conclusion, contrary to previous literature, SLI were not needed in the majority of dogs with PLE‐IBD (24/38 = 63%), which suggests a step‐wise treatment approach often used in IBD without PLE can be appropriate in these cases and might lower costs for drugs substantially. In addition, none of the clinicopathological parameters routinely assessed in these cases correlated with prognosis or outcome, illustrating the lack of useful markers to predict the clinical course of PLE‐IBD in dogs.