Description
Improving safety and efficacy of immunosuppressant drug use in small animal medicine by Nat Whitley. This webinar will cover use of traditional agents (glucocorticoids, azathioprine and chlorambucil) and newer agents (ciclosporin, mycophenolate and leflunomide) in the management of small animal immune mediated disease. For each of these drugs, the mode of action, available preparations, side effects and necessary monitoring will be described, along with the drugs most suitable for use in cats. Comparative drug costs will be shown. The niche role for vincristine in the management of canine immune mediated thrombocytopenia, and the fall from grace of cyclophosphamide as an immunosuppressant for dogs and cats are covered in detail. Pertinent literature, with an emphasis on new clinical and research findings will be mentioned to offer guidance on which drug may be most suitable for which disease. Specific immune mediated disease conditions mentioned include haemolytic anaemia, thrombocytopenia, polyarthritis and meningoencephlomyelitis. Owner and patient safety, ineffective and potentially detrimental medications and prescribing practices will be highlighted. Principles of combination therapy and drug weaning will be covered. Glucocorticoid use causes significant morbidity and the dogma that glucocorticoids are always the standard of care will be challenged, with discussion on ways to minimise steroid side effects and studies suggesting that monotherapies may can be effective in certain conditions. Adjunctive agents, such as antithrombotics will be mentioned briefly. Infectious and neoplastic complications of immunosuppressant use will be covered, with selected examples and references. Emerging techniques (such as pharmacodynamic monitoring of ciclosporin) and future strategies for individualising immunosuppressant choice and dosing (prospective evaluation of drug effect on an individual’s lymphocytes) offer promise for more refined future use of existing medications. Monoclonal antibody therapies are slowly gaining a foothold in veterinary oncology and are standard of care for some important human immune mediated conditions, such as rheumatoid arthritis. It is hoped that this may soon expand into more focussed management of some canine and feline immune mediated diseases.
Nat graduated from Glasgow Vet School in 1992 and pursued and internship and residency training in small animal medicine and cardiology in USA, gaining board certification in internal medicine in 1998. He spent a year teaching at Sydney University before undertaking a PhD in immunology at Bristol University, investigating new treatments for autoimmunity. He joined Davies Veterinary Specialists in 2005, where he is a director and Head of Medicine. Clinical interests include cardiology, gastroenterology, haematology and transfusion medicine, and immunology.