Abstract：
OBJECTIVE: To retrospectively evaluate safety and tolerance of leflunomide for long-term treatment of canine idiopathic immune-mediated polyarthritis (IMPA).
METHODS: 27 dogs with clinical signs and synovial fluid cytology supportive of IMPA with ≥ 6 months\' follow-up after starting leflunomide.
METHODS: Medical records were reviewed to identify dogs prescribed leflunomide for treatment of IMPA from February 2012 to May 2022. Initial leflunomide doses of 2 to 4 mg/kg once daily were prescribed and were titrated to the lowest effective dose with concurrent anti-inflammatory therapy. Complete blood count, serum chemistry, and clinical signs were monitored throughout the course of treatment.
RESULTS: Adverse effects potentially attributable to leflunomide noted in 9 of 27 dogs (33%) included vomiting, diarrhea, lethargy, decreased or absent appetite, polyuria and polydipsia, and secondary antibiotic responsive infection and were self-limiting or resolved with outpatient therapy. Alkaline phosphatase (ALP) and alanine aminotransferase (ALT) elevation were documented in all dogs prescribed leflunomide plus prednisone, with persistent liver enzyme elevation in 6 of 9 dogs (67%) and normalization after antibiotic therapy in 3 of 9 dogs (33%). The majority of dogs prescribed leflunomide plus NSAID (11/17 [65%] dogs) did not experience liver enzyme elevation; 2 of 17 (12%) dogs developed transient antibiotic-responsive liver enzyme elevations, and 4 of 17 (23%) dogs had persistent liver enzyme elevation.
CONCLUSIONS: Leflunomide was well tolerated for long-term management of IMPA. A significant difference in liver enzyme elevation was identified between dogs prescribed prednisone versus NSAID in combination with leflunomide. Leflunomide with NSAID therapy resulted in less hepatotoxicity compared with leflunomide with prednisone.
METHODS: 27 dogs with clinical signs and synovial fluid cytology supportive of IMPA with ≥ 6 months\' follow-up after starting leflunomide.
METHODS: Medical records were reviewed to identify dogs prescribed leflunomide for treatment of IMPA from February 2012 to May 2022. Initial leflunomide doses of 2 to 4 mg/kg once daily were prescribed and were titrated to the lowest effective dose with concurrent anti-inflammatory therapy. Complete blood count, serum chemistry, and clinical signs were monitored throughout the course of treatment.
RESULTS: Adverse effects potentially attributable to leflunomide noted in 9 of 27 dogs (33%) included vomiting, diarrhea, lethargy, decreased or absent appetite, polyuria and polydipsia, and secondary antibiotic responsive infection and were self-limiting or resolved with outpatient therapy. Alkaline phosphatase (ALP) and alanine aminotransferase (ALT) elevation were documented in all dogs prescribed leflunomide plus prednisone, with persistent liver enzyme elevation in 6 of 9 dogs (67%) and normalization after antibiotic therapy in 3 of 9 dogs (33%). The majority of dogs prescribed leflunomide plus NSAID (11/17 [65%] dogs) did not experience liver enzyme elevation; 2 of 17 (12%) dogs developed transient antibiotic-responsive liver enzyme elevations, and 4 of 17 (23%) dogs had persistent liver enzyme elevation.
CONCLUSIONS: Leflunomide was well tolerated for long-term management of IMPA. A significant difference in liver enzyme elevation was identified between dogs prescribed prednisone versus NSAID in combination with leflunomide. Leflunomide with NSAID therapy resulted in less hepatotoxicity compared with leflunomide with prednisone.
摘要：
目的：回顾性评价来氟米特长期治疗犬特发性免疫介导性多关节炎(IMPA)的安全性和耐受性。
方法：27只具有临床体征和滑液细胞学支持IMPA的犬，开始来氟米特后随访≥6个月。
方法：回顾了2012年2月至2022年5月的医疗记录，以确定使用来氟米特治疗IMPA的犬。每天一次开2至4mg/kg的初始来氟米特剂量，并在同时进行抗炎治疗的情况下滴定至最低有效剂量。全血细胞计数,血清化学,在整个治疗过程中监测临床体征。
结果：在27只狗中的9只（33％）可能归因于来氟米特的不良反应包括呕吐，腹泻,嗜睡,食欲下降或缺乏，多尿和多饮，和继发性抗生素反应性感染，并且是自限性或通过门诊治疗解决。碱性磷酸酶（ALP）和丙氨酸氨基转移酶（ALT）升高在所有规定的来氟米特加泼尼松的狗中记录，9只狗中的6只（67％）持续肝酶升高，抗生素治疗后9只狗中的3只（33％）恢复正常。大多数使用来氟米特加NSAID的狗（11/17[65％]狗）没有出现肝酶升高；17只狗中有2只（12％）出现短暂的抗生素反应性肝酶升高，17只狗中有4只（23％）有持续的肝酶升高。
结论：来氟米特对IMPA的长期管理具有良好的耐受性。在使用泼尼松与NSAID联合来氟米特的狗之间，发现肝酶升高存在显着差异。与泼尼松联合来氟米特相比，来氟米特联合NSAID治疗的肝毒性较小。
方法：27只具有临床体征和滑液细胞学支持IMPA的犬，开始来氟米特后随访≥6个月。
方法：回顾了2012年2月至2022年5月的医疗记录，以确定使用来氟米特治疗IMPA的犬。每天一次开2至4mg/kg的初始来氟米特剂量，并在同时进行抗炎治疗的情况下滴定至最低有效剂量。全血细胞计数,血清化学,在整个治疗过程中监测临床体征。
结果：在27只狗中的9只（33％）可能归因于来氟米特的不良反应包括呕吐，腹泻,嗜睡,食欲下降或缺乏，多尿和多饮，和继发性抗生素反应性感染，并且是自限性或通过门诊治疗解决。碱性磷酸酶（ALP）和丙氨酸氨基转移酶（ALT）升高在所有规定的来氟米特加泼尼松的狗中记录，9只狗中的6只（67％）持续肝酶升高，抗生素治疗后9只狗中的3只（33％）恢复正常。大多数使用来氟米特加NSAID的狗（11/17[65％]狗）没有出现肝酶升高；17只狗中有2只（12％）出现短暂的抗生素反应性肝酶升高，17只狗中有4只（23％）有持续的肝酶升高。
结论：来氟米特对IMPA的长期管理具有良好的耐受性。在使用泼尼松与NSAID联合来氟米特的狗之间，发现肝酶升高存在显着差异。与泼尼松联合来氟米特相比，来氟米特联合NSAID治疗的肝毒性较小。
