Evaluation of treatment with a combination of mycophenolate mofetil and prednisolone in dogs with meningoencephalomyelitis of unknown etiology: a retrospective study of 86 cases (2009-2017)

• Published in: BMC veterinary research 2020-06, Vol.16 (1), p.192-12, Article 192
• Main Authors: Song, Joong-Hyun, Yu, Do-Hyeon, Lee, Hee-Chun, Hwang, Tae-Sung, Kim, Young Joo, An, Su-Jin, Jung, Dong-In
• Format: Article
• Language: English
• Subjects: Animals; Anti-Inflammatory Agents - therapeutic use; Ataxia; Body weight; Convulsions & seizures; Development and progression; Dog Diseases - drug therapy; Dogs; Drug Therapy, Combination - veterinary; Drugs; Encephalitis; Etiology; Etiology (Medicine); Female; Glucocorticoids; Granulomatous meningoencephalitis (GME); Health aspects; Immunosuppressive agents; Immunosuppressive Agents - therapeutic use; Inflammatory diseases; Lymphocytes; Male; Medical records; Meningitis; Meningoencephalitis - drug therapy; Meningoencephalitis - mortality; Meningoencephalitis - veterinary; Meningoencephalomyelitis of unknown etiology (MUE); Metronidazole; Mycophenolate mofetil; Mycophenolate mofetil (MMF); Mycophenolic acid; Mycophenolic Acid - adverse effects; Mycophenolic Acid - therapeutic use; Necrotizing meningoencephalitis (NME); Pancreatitis; Prednisolone; Prednisolone - adverse effects; Prednisolone - therapeutic use; Recurrence; Retrospective Studies; Side effects; Survival; Survival analysis; Treatment Outcome; Zonisamide
• ISSN: 1746-6148; 1746-6148
• DOI: 10.1186/s12917-020-02414-3

Combination therapy with glucocorticoids and adjunctive immunomodulating drugs has been generally accepted as a standard treatment regimen for meningoencephalomyelitis of unknown etiology (MUE). We hypothesized that treatment with MMF as an adjunctive agent along with glucocorticoids would be effective and well-tolerated protocol in dogs with MUE. Eighty-six dogs with MUE between May 2009 and June 2017 were included (59 females and 27 males; mean age of 5.93 years; mean body weight of 3.83 kg). The medical records of dogs with MUE treated with prednisolone and MMF were retrospectively evaluated to determine the therapeutic response, survival time, and treatment-related adverse effects. A partial or complete response (CR) was recorded for 75 dogs. The overall median survival time from the initiation of treatment was 558 days. Dogs that showed CR with no relapse over the treatment period (from diagnosis to death) had significantly longer median survival times. A significantly higher mortality hazard ratio of 4.546 was recorded in dogs that failed to achieve CR. The interval between the onset of clinical signs and the clinical presentation was not significantly associated with CR, relapse rate, and survival time. Adverse effects included gastrointestinal upsets in 26 dogs (30.23%), sporadic infections in 17 dogs (19.77%), and pancreatitis in seven dogs (8.14%). The results suggest that adjunctive MMF treatment for MUE is safe and comparable to other immunosuppressive protocols. The treatment should focus on the achievement of CR and preventing relapse for successful management.