Chattering with iCatCare

This month Dr Nathalie Dowgray talks to Dr Sam Taylor about FIP. We're also featuring our monthly JFMS clinical spotlight interview in which Kelly St Denis discusses the feline chronic gingivostomatitis with Dr. Maria Soltero-Rivera.

To begin our episode, Nathalie is joined by fellow ISFM team member Sam Taylor. They discuss Sam's latest research on FIP which won the 2023 'scientific committee best abstract' award at the Dublin congress.

Kelly St Denis then sits down with Dr. Maria Soltero-Rivera to discuss her JFMS clinical spotlight article ‘Feline Chronic Gingivostomatitis - Current concepts in clinical management.’

Feline chronic gingivostomatitis is a challenging disease for both the cat and the veterinarian. They discuss the current and emerging science on the clinical management of this immune-mediated disease.

For further reading material please visit:

https://icatcare.org/app/uploads/2023/03/An-update-on-treatment-of-FIP-in-the-UK-2023.pdf

https://journals.sagepub.com/doi/full/10.1177/1098612X231194460

https://journals.sagepub.com/doi/epdf/10.1177/1098612X231186834

View The Transcript Here

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, MANCVS, FRCVS, Winner of the 2023 'scientific committee best abstract' Award, International Society of Feline Medicine, International Cat Care, Wiltshire, Tisbury, UK

Kelly St Denis, MSc, DVM, DABVP (Feline), 2022 ISFM/AAFP Cat Friendly Veterinary Environment Guidelines Co-Chair, St Denis Veterinary Professional Corporation, Powassan, Ontario, Canada

Maria Soltero-Rivera, DVM, DAVDC, Assistant Professor of Dentistry & Oral Surgery and published JFMS Author
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 and Guests

Host
Nathalie Dowgray

What is Chattering with iCatCare?

Welcome to Chattering With iCatCare, the official monthly podcast of International Cat Care, hosted by Yaiza Gomez-Mejias (Veterinary Community Co-ordinator). 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 iCatCare members at portal.icatcare.org. If you would like access to our full episodes, would like to become an iCatCare Veterinary Society Member, or find out more about our Cat-Friendly schemes, visit icatcare.org.

Nathalie Dowgray: Welcome to the
August 2023 episode of

Chattering with ISFM. I'm Dr.
Nathalie Dowgray, Head of ISFM

and host of this month's
podcast. First up this month I'm

going to be speaking with ISFM’s
own Dr. Sam Taylor. She's the

presenting author of the
scientific committee best

abstract award from our 2023
Congress, we're going to be

discussing her abstract which is
on the outcome of 307 cats

treated for FIP. And that was
with a combination of Remdesivir

and or GS 441524. We're also
going to be featuring our

monthly JFMS clinical spotlight
interview. And this month, this

is with Dr. Kelly St Denis
talking with Dr. Maria

Soltero-Rivera, about feline
chronic gingivostomatitis. We

hope you enjoy this episode.

So just to start with Sam, I was
really interested to know what

prompted you to start gathering
cases for this study.

Sam Taylor: We have been running
our FIP advice email service and

we set that up because we knew
that people would have questions

about these novel drugs. And we
also ourselves wanted to learn

and connect with people around
the world who were using the

drugs. And from that we've
worked out that there were some

of the same queries and some
different queries. And we

thought, can we bring this all
together to tell more people

about this collective
experience? If we could show

that they worked, and that they
were safe, and we could educate

people a little bit more on what
to look for adverse effect wise,

and then hopefully, as a
consequence, get these quality

kind of products where we know
what's in them, to more people

around the world.

Nathalie Dowgray: When you were
starting this process, and the

group of you were starting the
plans, how did you agree the

inclusion criteria, especially
for the diagnosis of FIP?

Sam Taylor: Yeah, and I think
that was really challenging. One

of the particularly challenging
things about a retrospective

like this is the variable, sort
of, levels of investigation that

are done. And we had, it's
another thing that I kind of

like about the study, but it was
also challenging, we had cases

treated in referral that had
MRI, CSF, PCR, you know, really

extensive investigation. And
then we had cats that were, you

know, quite understandably and
pragmatically treated based on

the likelihood of diagnosis. And
so we thought, how are we going

to handle that. And so what I
did is I reviewed all the cases,

and we categorised them
according to basically something

that the ABCD use. And so we
start off with these sort of

categories of being confirmed,
highly suspicious, and very

likely. And we thought that
might be a good way of looking

at the cases so that we could
still include those

pragmatically treated cases that
didn't have every bit of data.

And the other reason we wanted
to include all those cases,

because I wanted it to be real.
And if we just include those

cases that have had 1000s of
pounds of referral workup,

that's not real, that's not
relevant to the person who is

working in primary care. And so
we really wanted to have those

cats included. And I hope we've
managed to do it in that way.

Nathalie Dowgray: Brilliant.
Now, that's a really clever way

of doing it. And you managed to
include 307 cases, that's a

fantastic number. How many did
you have to exclude?

Sam Taylor: Well, not too many
is the answer. So things that we

excluded, we were very clear, we
wanted to exclude cats that have

been treated with black market
products for part of their

treatment, which in some
countries, and particularly in

the early treated cases, very
understandable that some of them

had some treatments in that way.
But that would mean we couldn't

interpret the results and the
effects of the treatments that

we wanted to study. So we
excluded those cats and then we

also excluded cats where, when I
followed their history or when

the vet submitted their history,
we didn't have enough

information on how they'd
responded and we couldn't

provide that level of detail. We
actually only excluded about 11

cases in the end.

Nathalie Dowgray: Brilliant.

Sam Taylor: In general, higher
doses give you better responses.

But the other thing I really
learnt from the study, which

probably is true of all cats is
this huge amount of variation.

So what really surprised me was
that some cats that were treated

with lower doses, that were very
sick, actually responded very

well. And then you've got other
cats that were treated with

higher doses that didn't do as
well. Although we will give

dosage advice, that should be
adapted to the individual,

depending on their response. We
weren't seeing adverse effects

with those high doses. So the
drugs do seem to be very well

tolerated. But lots of
individual variation. I never

thought we'd be here where we're
talking about 84% response to a

treatment when you have FIP in
the same sentence. So I'm hoping

you know that in another five
years, we'll have really

individualised treatment, we'll
have other drugs, we'll do

combination. I think it's, you
know, super exciting, where

we're gonna go with this.

Nathalie Dowgray: The full paper
from this abstract has now been

accepted for publication, so do
watch out for that in JFMS. Now

I'm going to be handing over to
Dr. Kelly St Denis talking with

Dr Maria Soltero-Rivera on her
JFMS clinical spotlight article

‘Feline Chronic
Gingivostomatitis: Current

concepts in the clinical
management’. Don't forget JFMS

is an open access journal now.
So the link to read that full

article is in the show notes.

Kelly St Denis: Welcome Dr.
Soltero-Rivera.

Maria Soltero-Rivera: Thank you,
Kelly. Thank you for having me.

Kelly St Denis: So some of your
focus on your research obviously

has been within the feline
dentistry aspect and obviously

FCGS. So in addition to just
diagnosing dental disease in

general, like Feline Chronic
Gingivostomatitis is something

that some clinicians struggle
with, because as we've learned

through the review article, one
of the main treatments is

surgical extraction. There's
always some hesitancy there. So

are there any tips that you
could give to clinicians that

would say help them to feel more
confident in that diagnosis on

observation and moving forward
with dental that you could

share?

Maria Soltero-Rivera: Yeah,
absolutely. It's a disease that

has been for some time
recognised grossly, and it

hasn't been recognised in more
objective ways. What I mean by

that is we've relied on people
looking at the oral cavity and

saying, yay or nay, it has
stomatitis. But I think we have

to remember that there are some
objective ways to characterise

the disease that we haven't been
as reliant on in the past that I

hope that we can bring into
light with this review. This is

a disease that affects different
areas of the oral mucosa, the

buccal mucosa is affected, the
alveolar mucosa is affected, and

you need to have all of those
affected, not just one or the

other. I think all of those need
to be affected. Where is the

inflammation centred, usually in
the back of the oral cavity

lateral to the palatoglossal
arches. And then you dive in and

you say, All right, what is here
microscopically. You want to

find lymphoplasmacytic
inflammation. We're currently

working on this theory that if
you see other cell types in

there, like eosinophils, things
can be a little bit different.

And we could be dealing with a
different subtype of this

disease. So I think
characterising the

histopathology is important to
confirm your suspicion, and to

see if there's anything that
could modify the disease or the

prognosis for these cats, and
then figuring out, Hey, how are

we doing in terms of viral
status, right? So is FeLV FIV

involved and FCV involved and
whenever possible, once there

becomes a commercial test, is
foamy virus involved? Because

all of these have been known to
modify the disease, if you will,

and certainly the response to
treatment can be affected by

these factors. It's not only the
oral cavity that's affected,

there are multiple systems
affected and that's what we're

trying to pull apart as we
continue to study this disease.

Kelly St Denis: Did you want to
tell us a little bit about how

someone decides between partial
versus full mouth extraction?

Maria Soltero-Rivera: Yeah, in
general, when you do your oral

evaluation, again, going back to
where is the inflammation

localised and extending to. In
our practice when the

inflammation extends all the way
rostrally to affect the incisors

and the canines, we recommend
full mouth extractions. It's

when those incisors and canine
teeth look a little bit less

effective or less effective
altogether. Sometimes you have

those that have the inflammation
just confined to the back of the

mouth, then you start thinking,
should I try to preserve teeth

and it's not wrong to take a
staged approach, but the

conversation with the client
should be very clear in that

this may not be curative. When
we look at those studies that we

did, comparing partial versus
full mouth extractions, we

didn't necessarily see a
significant difference in

response between the two
treatments. That said, we were

treating with partial mouth
extractions. So the patients

that didn't have that rosteral
involvement, right? So whether

we're treating the different
degree of severity, a different

manifestation or subtype of the
disease or treating other

diseases that were confusing
with FCGS? That's a good

question. I think that, again,
it's not wrong to start with

partial mouth extractions, if
the inflammation is only

confined to the caudal oral
cavity, it's just the way that

we present it to the clients
saying, this is, you and I are

going steady here. Now that
we're treating this patient.

Kelly St Denis: it's not a one
and done.

Maria Soltero-Rivera: This is
not a one and done. And we're

going to have to monitor them
closely. And if we have to come

back to extract the rest of the
teeth, we will, we will do that.

Kelly St Denis: Excellent. Thank
you so much. I've really enjoyed

chatting with you. And I hope
everyone has the opportunity to

check out the current concepts
in the clinical management of

Feline Chronic
Gingivostomatitis. Thank you,

Dr. Maria Soltero-Rivera, and
thank you to your colleagues as

well for this great review
article. And as I've said,

there's a lot of really
practical information in that

review article that you can use
in practice and some charts and

guidance that I think we all
could use on a day to day basis.

So definitely check it out, and
it is open access. So have a

look. Thanks again.

Maria Soltero-Rivera: Thank you

Nathalie Dowgray: Thank you for
listening. If you are an ISFM

veterinary member don’t forget
you can access the full version

of this podcast and all the
other ISFM veterinary membership

benefits including congress
recordings, monthly webinars,

our clinical club, the
discussion forum and much more

at portal.icatcare.org. We will
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