The Latest In Feline Infectious Peritonitis (FIP) (PART TWO)

Show Notes

This month we have the second of our two episodes about feline infectious peritonitis (FIP). In June 2022, ISFM Academy Lead Sam Taylor sat down at our Congress in Rhodes with professors Danièlle Gunn-Moore and Séverine Tasker to discuss the latest developments in the diagnosis and treatment of FIP.

We discuss how we managed to develop drugs for the treatment of FIP in the UK and Australia and how the response has been to those treatments so far. We also offer advice for monitoring our patients, how to navigate situations where there are financial challenges and how to discuss treatment plans with your clients (including what to do when a client buys medicine from the internet).


For further reading material please visit:

https://icatcare.org/advice/feline-infectious-peritonitis-fip/

http://www.abcdcatsvets.org/wp-content/uploads/2022/02/FIP_diagnostic_tool_Dec21.pdf

We hope you enjoy part two of this discussion. Tune in next month for the first of our JFMS Clinical Spotlight Interviews and an interview with Dr. Jessica Quimby.

For ISFM members, the full recording of this discussion is available for you to listen to at portal.icatcare.org. To become an ISFM member, or find out more about our Cat Friendly schemes, visit icatcare.org


Host:
Nathalie Dowgray, BVSc, MANZCVS, PgDip, MRCVS, PhD, Head of ISFM, International Society of Feline Medicine, International Cat Care,
Tisbury, Wiltshire, UK

Speakers:

Samantha Taylor, BVetMed(Hons) CertSAM DipECVIM-CA MANZCVS FRCVS, Feline Medicine Specialist and ISFM Academy Lead

Professor Séverine Tasker, BSc BVSc(Hons) PhD DSAM DipECVIM-CA FHEA FRCVS, Chief Medical Officer for the Linnaeus Group. Honorary Professor of Feline Medicine at the University of Bristol.

Professor Danièlle Gunn-Moore, BSc(Hon), BVM&S, PhD, MANZCVS (Feline), FHEA, FRSB, FRCVS,RCVS Specialist in Feline Medicine, Professor in Feline Medicine, Royal Dick School of Veterinary Studies and The Roslin Institute

For ISFM members, the full recording of this discussion is available for you to listen to at portal.icatcare.org. To become an ISFM member, or find out more about our Cat Friendly schemes, visit icatcare.org

Creators & Guests

Host

Nathalie Dowgray

What is Chattering With ISFM?

Welcome to Chattering With ISFM, the official monthly podcast of the International Society of Feline Medicine, hosted by Nathalie Dowgray (Head of ISFM). Each month, we chatter about cats and cat-friendly practices with industry experts and contributors to The Journal of Feline Medicine and Surgery. Each episode contains highlights from our longer discussions and interviews, which are accessible to ISFM members at portal.icatcare.org. If you would like access to our full episodes, would like to become an ISFM member, or find out more about our Cat-Friendly schemes, visit icatcare.org.

Nathalie Dowgray: Hello, welcome
to the third episode of

Chattering With ISFM. This month
we have the second of our two

episodes on feline infectious
peritonitis from ISFMs own Sam

Taylor, joining professors
Danièlle Gunn-Moore and Séverine

Tasker in discussing the latest
developments in the diagnosis

and treatment of FIP. We hope
you enjoy the second part of

their discussion.

Sam Taylor: You've been involved
in it, you know, sort of from

the beginning, do you think you
could just tell us a little bit

about those treatments? I
suppose the Australians had it

before us. What did we hear from
them that made us excited that

we wanted to get the drug?

Danièlle Gunn-Moore: Well, I
guess, take a little bit further

back. Because we've got both of
the cat world's professors,

we've got the majority of the
world's cat specialists, we

really, really targeted Gilead
who make remdesivir and we were

the only country where they
allowed us to use their

remdesivir in cats. And then we
targeted Nick Bova, and he has

this specials company. So we all
targeted him saying look please,

we really, really need these
drugs. And his company works in

Australia and here. The rules
for the veterinary medicines

directorate are much tougher in
Britain, a little bit easier in

Australia. So he managed to get
remdesivir. And then the GS, got

me doing it now, 44 15 24, into
Australia first, we got it

second. So that was all started,
year and a bit ago something

like that. The take up has been
much more in Britain, which I

thinks interesting because
they've had them for a year

longer. And yet we're about neck
and neck in number of cases,

we're 700 cases, as far as I
know, in each. So it's, we've

got a lot more in GS 44 than
we've got on remdesivir. They're

much more gung ho than we are.
They go with bigger doses

earlier. And they've taught us a
lot. There's certainly

differences between the doses of
the original papers. And what

we're now finding really you
need, which is, this is typical

of most studies. So the lowest
doses are just standard wet

form, then up a bit for dry
form, up a bit more for eyes, up

a bit more for brains. And when
you're getting up to those high

doses, you need to give it,
divide the dose because

otherwise you just don't get
enough absorbed. We're finding

side effects. Do you want me to,
shall I bounce that one too?

Sam Taylor: Yeah. Bounce that
one back.

Séverine Tasker: Yeah, side
effects that we've seen. Yeah. I

mean, generally, they're doing
okay, aren't they? I mean, from

the point of view of injectable,
the remdesivir, the injections

are painful. So we sometimes
need to sort of help with that

side of things, it can be given
subcutaneously as well as

intravenously. So there's things
like using Gabapentin and new

needles, there's lots of things.
And again, we've got a guide for

treatment, haven't we, that I'm
sure we can link to this podcast

as well, so that you've got all
of that information. In terms of

monitoring, these things that
we're talking about are coming

up because they're being
monitored. And obviously, it's

really nice. We want to see the
globulins come down, we want see

the AG ratio better. But don't
forget to weigh the cat. They're

young cats, they're often
growing. The fact that they're

putting on weight is fabulous.
So, that's brilliant. And it's

very cheap to weigh the cat as
well. But also just remember

about adjusting the amount, the
dose that you are giving to

preserve the dosage that you've
prescribed for that cat. Yeah.

Sam Taylor: So how do you
monitor them? What would, what

advice do you give about
monitoring? Are there, depends

how sick they are, of course,
but are there any points that

you would want to have them in
and do bloods? Or?

Danièlle Gunn-Moore: I'm not
sure we've got any gold rules.

It does depend a lot, some of
them really aren't that bad to

start with, you start the GS and
they go in brilliantly, and you

just go okay, fine. Particularly
if money's limited. If I could,

I would like to have them when
they go home, after two weeks, a

month. And then ideally, I'd
love every month, but they've

got to have good insurance or a
lot of money for that. Yeah. But

it means I can really monitor
them. And you can then,

particularly as you're coming up
to the 12 weeks, you want to

know everything's normal, other
than the ALT. I'll accept that

the ALTs still being up. But I
want to know that particularly

the AGP, so the acute phase
protein, I want to see that

normalised. And the AG ratio, I
want that normal and I want the

anaemia gone.

Séverine Tasker: Yeah. And I
agree. And I think you know, if

money is an issue, preserving it
for towards the end treatment,

because you want to be as
confident as you can be taking

them off, because there are
cases that do need longer, and

that, those are the really
important ones. If they're doing

clinically brilliantly, then try
and preserve that cost for the

proteins towards the end.

Danièlle Gunn-Moore: Therapeutic
drug monitoring may be a good

way to go. But then it's other
drugs that you can either add in

or switch to. At the moment, we
tending to add in aren’t we,

either Mefloquine and or
Polyprenyl Immunostimulant.

There's certainly a good
argument for, if you've got one

that's just swithering, it's not
doing as well as you'd like.

Then add in either Polyprenyl
Immunostimulant, or

Interferon-omega, because they
would both be an immune

modulator, which that makes
sense, an antiviral with an

immune modulator. If the
antivirals really not working,

then mefloquine is where we're
going, although sometimes we're

using those two together, aren't
we? Trying to look for a

synergistic effect?

Séverine Tasker: Yeah,

Sam Taylor: We can treat them
just orally

Danièlle Gunn-Moore: Yes.

Sam Taylor: Because thats
another question we get asked.

Séverine Tasker: Absolutely,

Danièlle Gunn-Moore: absolutely.

Séverine Tasker: Yeah,
absolutely. I mean, we, you

know, we've gone for the
remdesivir to start with,

because we've learned so much
from the Australians, but there

are quite a lot of publications
out there with just oral

treatment with the oral GS, and
that is cheaper.

Danièlle Gunn-Moore: If they
weren't neuro or opso cases,

then I think that's very
appropriate. Yeah.

Sam Taylor: Because I guess we
don't know, we don't have the

data to say that there's a
benefit of using two weeks of

remdesivir

Séverine Tasker: No, no, no,
no, no, no, there's no publish,

to compare oral GS with, you
know, I think sometimes when

they're really sick and
hospitalised, you know, the

injectable to start with

Danièlle Gunn-Moore: Because
they're too poor to swallow.

Also, there is the concept, you
know, that remdesivir, because

of how different it is, only a
little bit, but it is more

bioavailable to cells. So it
gets into cells better, isn't

it? So on that reasoning, it's
more side effects, but more

potency. So therefore, when
you're trying to get into

difficult places, then let's go
as potent as we can.

Séverine Tasker: But if finances
are an issue, then I think the

oral GS straight off is
definitely a valid way to go.

Sam Taylor: And I've also found
that sometimes people, they’re

very anxious about giving
tablets.

Séverine Tasker: Yeah

Sam Taylor: i know it's really,
really hard.

Danièlle Gunn-Moore: If they're
really not sure I’ve said,

‘let's try it, let's see where
we are in three days’, you know,

you're not saying ‘this awful,
sick, poorly cat has got to have

12 weeks of treatment’. And
they're just going ‘oh, he

couldn't take it’. Your going
‘Look let's just see, just give

me three days.’ And you go
‘well, let's just get to the end

of the week’, and then they can
go actually 12 weeks won't be

too much trouble.

Séverine Tasker: And I think
just one last thing, just about

a client without too much money
is just remembering that you,

like you said, you’ve just got
to make sure you've documented

in the notes, your conversations
because

Sam Taylor: Actually around all
of this treatment because it's

not guaranteed. And yes, it's
really successful. And we've

seen great success, but not
every cat. I would, I'd hate

owners have the impression this
is guaranteeing you a cure

Danièlle Gunn-Moore: We have had
some that have presumed that

Sam Taylor: You spend 6000
pounds, and you're going to have

your kitten back, just like it
doesn't work with any other

disease really. But I think in
this one it’s, you’ve got to

write it down Absolutely
So they understand the

limitations of the treatments.

Séverine Tasker: It's not a
guarantee. But we're doing our

best, especially when we can't
do the full course. Yeah,

Sam Taylor: We don't want to shy
away from it. You can buy these

drugs on the internet. And we
know that they have widely been

used from internet sources. And
we'll have people watching from

all around the world. How do you
handle that situation? Or how do

we advise vets?

Séverine Tasker: Yeah, I mean,
it's really hard, isn't it? And

I know we've got a global
audience, I think, I think it's

a matter of, you know, reaching
out and finding out what the

regulations are in your country,
what is available, what is, if

there is anything legal to use,
you know, there's been

publications out there with
those black market drugs. So we

know that they work, the problem
is that we have no data on

what's in them, the amount
that's in them, people aren't

allowed to buy them because
they're importing them as a

medicine and that is illegal,
and where we can't prescribe or

use them ourselves. So that is
pretty clear in terms of the

legalities of it.

Danièlle Gunn-Moore: It's not
just we, it's all British vets.

Séverine Tasker: Yeah,

Danièlle Gunn-Moore: We can't
touch it, we can lose our MRCVS,

it's that serious.

Séverine Tasker: So I think the
thing is that if somebody does

come across, I mean it depends
where you are, but I mean in the

UK, we have got some, we are
very lucky that we've got access

to legally available products
now and that is absolutely the

route that we should go down. If
you are a vet that is dealing

with a client that is, off their
own back, ordered them online,

have got the drug, you know
there is an argument for you

being able to monitor and help
with the welfare of that cat

because I think pushing it to
the back, even when you've

talked to the owner in that way,
and they don't get any

veterinary care is almost worse,
you know.

Nathalie Dowgray: Thank you for
listening to Chattering with

ISFM. The full version of this
roundtable discussion is

available to ISFM veterinary
members, along with an

additional interview from Dr.
Dottie Laflamme. To access that

and all other ISFM member
benefits, including recordings

from Congress's, monthly
webinars, the discussion forum

and much more, do login to
portal.icatcare.org. If you're

not an ISFM member, then please
do visit icatcare.org to learn

more. Tune in next month for the
first of our JFMS Clinical

Spotlight Interviews and an
interview with Dr. Jessica

Quimby.