Treatment of Evans’ Syndrome With Human Intravenous Immunoglobulin and Leflunomide in a Diabetic Dog

ArticleinJournal of the American Animal Hospital Association 45(3):147-50 · May 2009with15 Reads
DOI: 10.5326/0450147 · Source: PubMed
Abstract
An 11-year-old, spayed female miniature schnauzer with diabetes mellitus was presumptively diagnosed with Evans' syndrome (ES). Because of the potential adverse effects of immunosuppressive doses of glucocorticoids in a diabetic dog, a single infusion of human intravenous immunoglobulin and oral leflunomide were used as first-line immunomodulatory therapy, after informed owner consent was received. This treatment resulted in complete remission of the ES, and leflunomide was discontinued after 10 months of therapy. Over a 19-month follow-up, the dog did not relapse and has remained a well-regulated diabetic.
    • "Despite reported usage, the efficacy of other agents (cyclophosphamide, azathioprine and danazol) in canine IMTP is not documented by controlled studies or limited to very small numbers of cases ( Williams and Maggio-Price 1984, Jackson and Kruth 1985, Bloom and others 1989, Jans and others 1990, Roseler and Mason 1994). Leflunomide monotherapy eventually maintained normal platelet counts in two of three dogs previously receiving other therapies (Gregory and others 1998b) and a combination of leflunomide and IVIG was recently described for successful management of Evans' syndrome in a dog (Bianco and Hardy 2009). Ciclosporin has also been described for successful management of chronic IMTP refractory to prednisolone in three dogs, although a fourth dog died from systemic aspergillosis that may have been precipitated by immunosuppression (Cook and others 1994). "
    [Show abstract] [Hide abstract] ABSTRACT: This review summarises the current understanding of immune response and T cell subsets in the context of development of autoimmunity in the dog. Mode of action and rational usage in immune-mediated disease in the dog are discussed for the following drugs: glucocorticoids, azathioprine, cyclophosphamide, ciclosporin, tacrolimus, human intravenous immunoglobulin, vincristine, danazol, leflunomide, mycophenolate mofetil and liposome-encapsulated clodronate. Disease mechanisms are discussed and published evidence for drug efficacy is scrutinised for five important immune-mediated diseases: immune-mediated haemolytic anaemia, immune-mediated thrombocytopenia, myasthenia gravis, glomerulonephritis and inflammatory bowel disease. Future strategies for more refined manipulation of adverse immune responses are presented.
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  • [Show abstract] [Hide abstract] ABSTRACT: Leflunomide, an immune modulatory prodrug that is rapidly converted to its active metabolite possibly in the gut wall, plasma and in the liver was microencapsulated by the solvent evaporation technique using a nonaqueous solution of polymethacrylate polymer to achieve its release from the microcapsules at a slower rate. At the optimal condition of process variables such as stirring speed, temperature of the medium, drug polymer ratio and ratio of light liquid paraffin and heavy liquid paraffin, maximum encapsulation efficiency was obtained. These microspheres were free-flowing in nature, discrete and uniform spherical in size, as evident by scanning electron microscopy. The in vitro release experiments were carried out in the simulated intestinal fluid (pH 7.2 phosphate buffer) using united States Pharmacopoeia (USP) XXII apparatus II. The data obtained from the dissolution profiles were compared using different kinetics models and the regression coefficients were compared.
    Article · Oct 2009
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