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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - ? about Azathioprine and cyclosporine
| Wylie was just put in Azathioprine since her HCT is 27. I think I read this can cause side effects and take longer to work than cyclosporine? Can you fill me in on why use one over the other and is one safer, less side effects? And what do these drugs do? Thank you so much Laurie |
| Laurie CA |
| My vet has been reluctant to start Azathioprine. Does any one know why? |
| Rona ca |
| Joanne has a pretty good description of some of the drugs used for treatment on her website: http://www.cloudnet.com/~jdickson/treatment.htm Under this topic she refers to azathioprine: "If steroids alone are insufficient, more potent immunosuppressive drugs such as azathioprine, sold under the brand name Imuran may be added. Imuran is a "second-line" or "slow acting drug." Clinical response may require up to 6 weeks. The principal adverse effect associated with Imuran is bone marrow suppression. Acute pancreatitis and hepatotoxicity have also been associated with Imuran. Because Imuran depresses the immune system, animals may be susceptible to infections or neoplastic illnesses (long term use)." Bone marrow is where the body makes Red blood cells, white blood cells and platelets. Suppression of this process would probably be interference with the RNA process that makes these cells. So rbc might not be made in enough numbers to recover the losses by the body. Acute means a very sudden and severe problem. Pancreatitis is an inflammation of the pancreas. This is a twofold problem. The pancreas secretes digestive enzymes that are channeled via a duct to the digestive organ (small intestine). It also produces insulin, a hormone that assists the body in keeping blood sugar at a certain level. If the pancreas is inflamed, digestive enzymes can actually begin to digest the pancreas, this is very painful. If the pancreas becomes severely damaged, it can reduce or stop the production of insulin. Hepatotoxicity is a term that means the liver becomes inflamed, unable to process all the toxins that the body sends it to process. The cells can begin to die from exposure to these toxins. The liver is regenerative and can recover from this in many cases. When there are a number of liver cells dying and being replaced, enzymes are released into the bloodstream in great numbers. These enzymes show up on blood tests as (alk phos) alkaline phosphatase and (alt) alanine aminotransferase in very high numbers. Neoplastic illnesses means that cells can begin to become cancerous. Cyclosporine is a targeted drug, made from a fungus. It was developed many years ago when organ transplantation became popular. In order to prevent the human body from rejecting the "not self" organ, doctors had to suppress the immune system so it wouldn't attack the new organ. They used prednisone because it had been discovered to do this quite well. However, long term use of prednisone leads to a severe depression of all white blood cells, not just the particular kind call t-cell or t-lymphocytes or killer cells. These are the wbc most responsible for this kind of attack. This left the human body very susceptible to many infections and they found that many of these patients died not from organ rejection, but infections. Cyclosporine targets just these t-lymphocytes in a very controlled mechanism and leaves most of the other parts of the immune system intact. This allowed doctors to suppress the part of the immune system that caused the most damage, but allowed the body to fight infections with other parts of the immune system. The side effects were much less and these patients were more successful in keeping their new organs. Cyclosporine has come recently to the canine vet field in the form called Atopica, used for dogs that have atopic dermatitis or allergies. It was found to work extraordinarily well. Dr. Dodds was a maverick in leading the vet community in using cyclosporine in treating AIHA and IMHA and originally used the human medications Neoral and Sandimmune. Neoral is the same formulation as Atopica. Atopica (or Neoral) are not marketed for use in canine AIHA and the company will not recommend it's use because there have not been drug trials for this use. But many drugs are used off label in this county so it has become very popular in recent years. Some dogs experience some digestive side effects that are severe enough that they cannot tolerate it. Other dogs, like my Chance, tolerate it quite well and actually recover from extremely severe cases of AIHA. Treatment of AIHA is not a defined science and each instance is a trial that requires the clinical experience of the practicing vet. Vets will find particular success with a certain protocol and will continue to use that rather than another protocol specifically because of thei clinical experience. patrice |
| Patrice NYS |
| Patrice, that first paragraph is what I am talking about. Wylie has been on the pred and azi for 2 weeks now and after 7 days already was up from 27 to 31. She goes in today for another test, if its up I am going to discuss stopping the azi Laurie |
| Laurie CA |
This thread was discussed between 01/11/2008 and 14/11/2008
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