PDF(Pubmed)
Abstract：
BACKGROUND: Meningoencephalitis of unknown origin is a common cause of severe neurological disease in dogs. The term covers a heterogeneous group of noninfectious inflammatory diseases, with immune dysregulation widely accepted as the underlying disease mechanism. Current treatment consists of immunosuppression, with corticosteroids being the mainstay of virtually all treatment regimens. However, side effects of corticosteroids can be severe, and might be the cause of death in some patients. This retrospective, multi-centric study aimed at describing a population of Scandinavian dogs with meningoencephalitis of unknown origin in regards to reported side effects and cause of death, and to highlight possible differences in survival, when comparing corticosteroid monotherapy with other treatment regimens.
RESULTS: Within the 5-year study period, 63 dogs were included. Of these, 35 (49.3%) died or were euthanized during the study period. Median survival time from time of diagnosis based on Kaplan-Meier curves for the overall population was 714 days (equivalent to around 25 months, range 0-1678 days). There was no statistically significant difference (P = 0.31) in survival between dogs treated with corticosteroid monotherapy (n = 26, median survival time 716 days, equivalent to around 25 months, range 5-911 days), dogs receiving a combination of corticosteroids and ciclosporin (n = 15, median survival time 916 days, equivalent to around 31 months, range 35-1678 days), and dogs receiving corticosteroids combined with either cytosine arabinoside, leflunomide, or a combination of 2 or more add-on drugs (n = 13, median survival time 1186 days, equivalent to around 40 months, range 121-1640 days). Side effects were registered for 47/63 dogs. Polyphagia (n = 37/47), polyuria/polydipsia (n = 37/47), diarrhea (n = 29/47) and lethargy (n = 28/47) were most frequently reported. The most common cause for euthanasia was relapse (n = 15/35, 42.9%), followed by insufficient or lack of treatment response (n = 9, 25.7%). Side effects were the direct cause of euthanasia in 2/35 dogs (5.7%).
CONCLUSIONS: A large proportion of dogs in the overall population were euthanized due to relapse, emphasizing a need for treatment regimens aimed at specifically preventing relapse for an improved long-term survival. Side effects in dogs receiving corticosteroid monotherapy were rarely a direct cause of death, but were reported for all dogs. No statistically significant difference in survival was found when corticosteroid monotherapy was compared to other treatment regimens.
RESULTS: Within the 5-year study period, 63 dogs were included. Of these, 35 (49.3%) died or were euthanized during the study period. Median survival time from time of diagnosis based on Kaplan-Meier curves for the overall population was 714 days (equivalent to around 25 months, range 0-1678 days). There was no statistically significant difference (P = 0.31) in survival between dogs treated with corticosteroid monotherapy (n = 26, median survival time 716 days, equivalent to around 25 months, range 5-911 days), dogs receiving a combination of corticosteroids and ciclosporin (n = 15, median survival time 916 days, equivalent to around 31 months, range 35-1678 days), and dogs receiving corticosteroids combined with either cytosine arabinoside, leflunomide, or a combination of 2 or more add-on drugs (n = 13, median survival time 1186 days, equivalent to around 40 months, range 121-1640 days). Side effects were registered for 47/63 dogs. Polyphagia (n = 37/47), polyuria/polydipsia (n = 37/47), diarrhea (n = 29/47) and lethargy (n = 28/47) were most frequently reported. The most common cause for euthanasia was relapse (n = 15/35, 42.9%), followed by insufficient or lack of treatment response (n = 9, 25.7%). Side effects were the direct cause of euthanasia in 2/35 dogs (5.7%).
CONCLUSIONS: A large proportion of dogs in the overall population were euthanized due to relapse, emphasizing a need for treatment regimens aimed at specifically preventing relapse for an improved long-term survival. Side effects in dogs receiving corticosteroid monotherapy were rarely a direct cause of death, but were reported for all dogs. No statistically significant difference in survival was found when corticosteroid monotherapy was compared to other treatment regimens.
摘要：
背景：不明原因的脑膜脑炎是狗严重神经系统疾病的常见原因。该术语涵盖一组异质性的非感染性炎性疾病，免疫失调被广泛认为是潜在的疾病机制。目前的治疗包括免疫抑制，皮质类固醇是几乎所有治疗方案的支柱。然而,皮质类固醇的副作用可能很严重，可能是一些病人的死因.这次回顾，多中心研究旨在描述斯堪的纳维亚犬群患有未知来源的脑膜脑炎，关于报告的副作用和死亡原因，并强调可能的生存差异，当比较皮质类固醇单一疗法与其他治疗方案时。
结果：在5年的研究期内，包括63只狗。其中,35人(49.3%)在研究期间死亡或被安乐死。根据Kaplan-Meier曲线，从诊断时间开始的中位生存时间为714天（相当于约25个月，范围0-1678天）。用皮质类固醇单一疗法治疗的狗之间的生存率没有统计学上的显着差异（P=0.31）（n=26，中位生存时间716天，相当于25个月左右,范围5-911天)，接受皮质类固醇和环孢素组合的狗（n=15，中位生存时间916天，相当于31个月左右，范围35-1678天)，接受皮质类固醇联合阿糖胞苷的狗，来氟米特,或2种或更多种附加药物的组合(n=13，中位生存时间1186天，相当于大约40个月，范围121-1640天）。对47/63只狗进行了副作用记录。多食（n=37/47），多尿/多饮（n=37/47），腹泻(n=29/47)和嗜睡(n=28/47)最常见.安乐死最常见的原因是复发（n=15/35，42.9％），其次是治疗反应不足或缺乏（n=9，25.7%）。副作用是2/35犬（5.7％）安乐死的直接原因。
结论：总体人群中很大比例的狗因复发而被安乐死，强调需要专门预防复发以改善长期生存率的治疗方案。接受皮质类固醇单一疗法的狗的副作用很少是直接死亡原因，但所有的狗都有报道。当皮质类固醇单药治疗与其他治疗方案相比时，没有发现统计学上的显着差异。
结果：在5年的研究期内，包括63只狗。其中,35人(49.3%)在研究期间死亡或被安乐死。根据Kaplan-Meier曲线，从诊断时间开始的中位生存时间为714天（相当于约25个月，范围0-1678天）。用皮质类固醇单一疗法治疗的狗之间的生存率没有统计学上的显着差异（P=0.31）（n=26，中位生存时间716天，相当于25个月左右,范围5-911天)，接受皮质类固醇和环孢素组合的狗（n=15，中位生存时间916天，相当于31个月左右，范围35-1678天)，接受皮质类固醇联合阿糖胞苷的狗，来氟米特,或2种或更多种附加药物的组合(n=13，中位生存时间1186天，相当于大约40个月，范围121-1640天）。对47/63只狗进行了副作用记录。多食（n=37/47），多尿/多饮（n=37/47），腹泻(n=29/47)和嗜睡(n=28/47)最常见.安乐死最常见的原因是复发（n=15/35，42.9％），其次是治疗反应不足或缺乏（n=9，25.7%）。副作用是2/35犬（5.7％）安乐死的直接原因。
结论：总体人群中很大比例的狗因复发而被安乐死，强调需要专门预防复发以改善长期生存率的治疗方案。接受皮质类固醇单一疗法的狗的副作用很少是直接死亡原因，但所有的狗都有报道。当皮质类固醇单药治疗与其他治疗方案相比时，没有发现统计学上的显着差异。
