JAVMA, Vol 242, No. 12, June 15, 2013 Scientific Reports 1705 SMALL ANIMALS/ AVIAN P rotein-losing enteropathy is a syndrome character- ized by loss of albumin through the intestinal wall and has been reported in many breeds including Ba- senji, German Shepherd Dog, Rottweiler, Soft-Coated Wheaten Terrier, and Yorkshire Terrier. 1 Various intesti- nal lesions can be responsible for the protein loss; pri- mary and secondary lymphangiectesia have both been described as well as CEs characterized by inflammation of the intestines, infectious or parasitic diseases, and neoplastic diseases. 1 When PLE arises secondary to CE, it is usually con- sidered to have a guarded prognosis because of the un- predictable response to treatment and risk of relapse. 1 Comparison of a chlorambucil-prednisolone combination with an azathioprine-prednisolone combination for treatment of chronic enteropathy with concurrent protein-losing enteropathy in dogs: 27 cases (2007–2010) Julien R. S. Dandrieux, Dr med vet, DACVIM; Peter-John M. Noble, BVM&S, PhD; Timothy J. Scase, BVM&S, PhD, DACVP; Peter J. Cripps, BVSc, PhD; Alexander J. German, BVSc, PhD Objective—To compare treatment protocols for chronic enteropathy and concurrent pro- tein-losing enteropathy that used prednisolone in conjunction with either azathioprine or chlorambucil in dogs. Design—Retrospective case series. Animals—27 dogs. Procedures—All dogs had hypoalbuminemia (serum albumin concentration, < 18.0 g/L) and chronic enteropathy as diagnosed via complete gastrointestinal tract investigations including intes- tinal biopsy. Dogs received either an azathioprine-prednisolone combination (group A; n = 13) or a chlorambucil-prednisolone combination (group C; 14). Response to treatment was assessed by evaluation of body weight gain, serum albumin concentration, and duration of primary treatment. Results—No significant pretreatment differences were detected between groups for any baseline variable (signalment and weight), clinicopathologic variable (albumin, cobalamin, and folate concentrations), or histopathologic findings. After treatment, serum albumin concentra- tion and weight gain were significantly greater in group C. Median survival time for group A dogs was 30 days (95% confidence interval, 15 to 45 days) and was not reached for group C dogs. Duration of primary treatment was positively associated with the histopathologic pres- ence of mild lacteal dilatation and use of a chlorambucil-prednisolone combination. Conclusions and Clinical Relevance—Results suggested that a chlorambucil-predniso- lone protocol is more efficacious for treatment of chronic enteropathy and concurrent pro- tein-losing enteropathy, compared with an azathioprine-prednisolone combination. Given these findings, a prospective randomized clinical trial is warranted. (J Am Vet Med Assoc 2013;242:1705–1714) Survival is usually poor with published reports estimat- ing a 66% death rate within 5 months in 1 study on hypercoagulability in PLE-affected dogs 2 and a 47% 1-year survival rate in Rottweilers with PLE. 3 Recent re- search abstracts also report either a 32% mortality rate within 2 years a or up to a 58% risk of death b,c in such cases. Two abstracts have reported mean survival times for dogs with PLE of 90 days (range, 2 to 2,544 days) d and 701 days. e However, specific details regarding the ex- act treatments used in those 2 studies were not reported. Given that hypoalbuminemia is a negative prog- nostic indicator in cases of CE, 4,5 most clinicians use aggressive immunosuppressive combination treatments in such cases. Although the efficacy of immunosuppres- sive treatment has been assessed in other diseases, in- cluding immune-mediated hemolytic anemia, 6–9 atopic dermatitis, 10 and anal furunculosis, 11,12 information re- garding efficacy of immune-suppressive treatment for From the School of Veterinary Science (Dandrieux, Noble, Cripps, German), University of Liverpool, Neston CH64 7TE, England; and Bridge Pathology Ltd, PO Box 2877, Bristol, BS8 9FH, Eng- land (Scase). Dr. Dandrieux’s present address is University of Mel- bourne, Werribee, VIC 3030, Australia. The work was performed at the School of Veterinary Science, University of Liverpool, Neston, England. Dr. German’s senior lectureship was funded by Royal Canin. Presented in abstract form at the 21st European College of Veteri- nary Internal Medicine Annual Congress, Seville, Spain, September 2011. Address correspondence to Dr. Dandrieux (jdandrieux@gmail.com). ABBREVIATIONS CE Chronic enteropathy CI Confidence interval PLE Protein-losing enteropathy Unauthenticated | Downloaded 03/08/24 10:40 PM UTC