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霉酚酸酯治疗犬疑似特发性慢性肝炎:六例病例报告(2010-2022 年)。

Mycophenolate mofetil as a treatment for presumed idiopathic chronic hepatitis in dogs: Six cases (2010-2022).

机构信息

Department of Internal Medicine, Angell Animal Medical Center, Boston, Massachusetts, USA.

出版信息

Vet Med Sci. 2023 Nov;9(6):2527-2533. doi: 10.1002/vms3.1261. Epub 2023 Sep 2.

DOI:10.1002/vms3.1261
PMID:37659075
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10650243/
Abstract

OBJECTIVES

The objectives of this study were to describe the clinical findings, treatment and outcomes of six dogs with presumed idiopathic chronic hepatitis treated with mycophenolate mofetil (MMF).

MATERIALS AND METHODS

Medical records were retrospectively searched to identify dogs in which idiopathic chronic hepatitis was diagnosed on histopathology between January 2010 and June 2022 that were treated with MMF for at least two weeks with >2 follow-up examinations. Data recorded from each dog included signalment, clinical signs, diagnostic test results and treatment.

RESULTS

Six dogs were treated with MMF at a median initial dosage of 9.6 mg/kg PO q 12 h. Reported adverse effects from MMF included decreased appetite, vomiting and diarrhoea. In all six dogs, MMF was used successfully long term for the treatment of idiopathic chronic hepatitis as determined by 46% or greater improvement of alanine aminotransferase (ALT) between 4 and 18 weeks of starting MMF. Three dogs were also temporarily treated for 4-6 months on a tapering dose of prednisone. In two dogs, ALT remained within the reference interval, and in one dog, it was very mildly elevated when on MMF alone. In all six dogs, owners reported that the medication was well tolerated.

CLINICAL SIGNIFICANCE

To the authors' knowledge, this is the first report describing the use of MMF with and without a tapering dose of prednisone for the treatment of idiopathic chronic hepatitis in six dogs. Based on the outcomes of the dogs in this report, MMF can be effective for the long-term treatment of idiopathic chronic hepatitis as measured by reduction in ALT and improvement of clinical signs.

摘要

目的

本研究的目的是描述 6 只疑似特发性慢性肝炎的犬用吗替麦考酚酯(MMF)治疗的临床发现、治疗方法和结果。

材料和方法

回顾性检索病历,以确定 2010 年 1 月至 2022 年 6 月期间在组织病理学上诊断为特发性慢性肝炎且至少用 MMF 治疗 2 周且随访检查≥2 次的犬。从每只犬记录的资料包括一般信息、临床症状、诊断试验结果和治疗。

结果

6 只犬以 9.6mg/kg PO q12h 的初始剂量中位数接受 MMF 治疗。MMF 的不良反应包括食欲下降、呕吐和腹泻。在所有 6 只犬中,MMF 成功地长期用于治疗特发性慢性肝炎,从开始使用 MMF 后 4 至 18 周内,丙氨酸氨基转移酶(ALT)改善 46%或以上。3 只犬还接受了 4-6 个月的泼尼松逐渐减量治疗。在 2 只犬中,ALT 在参考区间内,在 1 只犬中,单独使用 MMF 时,ALT 仅轻度升高。在所有 6 只犬中,主人均报告药物耐受性良好。

临床意义

据作者所知,这是首次报道用 MMF 联合或不联合泼尼松逐渐减量治疗 6 只犬特发性慢性肝炎。根据本报告中犬的结果,MMF 可有效治疗特发性慢性肝炎,可通过降低 ALT 和改善临床症状来衡量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ee8a/10650243/095021559daa/VMS3-9-2527-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ee8a/10650243/8f17e6210780/VMS3-9-2527-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ee8a/10650243/095021559daa/VMS3-9-2527-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ee8a/10650243/8f17e6210780/VMS3-9-2527-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ee8a/10650243/095021559daa/VMS3-9-2527-g003.jpg

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J Vet Intern Med. 2021 Sep;35(5):2215-2221. doi: 10.1111/jvim.16209. Epub 2021 Jul 6.
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Retrospective evaluation of cyclosporine in the treatment of presumed idiopathic chronic hepatitis in dogs.回顾性评估环孢素治疗犬疑似特发性慢性肝炎的效果。
J Vet Intern Med. 2019 Sep;33(5):2046-2056. doi: 10.1111/jvim.15591. Epub 2019 Aug 8.
3
ACVIM consensus statement on the diagnosis and treatment of chronic hepatitis in dogs.
ACVIM 共识声明:犬慢性肝炎的诊断与治疗。
J Vet Intern Med. 2019 May;33(3):1173-1200. doi: 10.1111/jvim.15467. Epub 2019 Mar 7.
4
Autoimmune hepatitis: Current and future therapeutic options.自身免疫性肝炎:当前和未来的治疗选择。
Liver Int. 2019 Jun;39(6):1002-1013. doi: 10.1111/liv.14062. Epub 2019 Mar 7.
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Efficacy and Safety of Mycophenolate Mofetil in Patients With Autoimmune Hepatitis and Suboptimal Outcomes After Standard Therapy.霉酚酸酯治疗标准治疗后应答不佳的自身免疫性肝炎患者的疗效和安全性。
Clin Gastroenterol Hepatol. 2018 Feb;16(2):268-277. doi: 10.1016/j.cgh.2017.09.063. Epub 2017 Oct 16.
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