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Glycosaminoglycans in cats with FLUTD

Clinical Scenario

Bertie is an 8 year old male neutered domestic short haired cat who has suffered long term problems with non-obstructive feline lower urinary tract disease (FLUTD). He is already on dietary and environmental control and his owners have tried other treatments without any success in reducing his clinical signs. His owners are keen to try any other treatments available and you wonder if an oral glycosaminoglycan supplement you heard about on a CPD course would help reduce Bertie's clinical signs…

3-Part Question (PICO)

In [cats with non-obstructive lower urinary tract disease] does [the use of oral glycosaminoglycans or their precursors compared to placebo] [reduce clinical signs]?

Search Strategy and Summary of Evidence

Search Strategy

MEDLINE(R) In-Process & Other Non-Indexed Citations and MEDLINE(R) 1946 to Present using the OVID interface

(cat.mp. OR cats.mp. OR feline.mp. OR felines.mp. OR felis.mp. OR exp Cats/)

AND

(FLUTD.mp. OR cystitis.mp. OR lower urinary tract.mp. OR urological syndrome.mp. OR urologic syndrome.mp. OR FUS.mp. OR FIC.mp. OR exp urologic diseases/)

AND

(GAG.mp. OR GAGs.mp. OR glycosaminoglycan.mp. OR glycosaminoglycans.mp. OR pentosan polysulphate.mp. OR pentosan polysulfate.mp. OR elmiron.mp. OR glucosamine.mp. OR glucosamines.mp. OR cystaid.mp. OR cystease.mp. OR exp Glycosaminoglycans/ OR exp Pentosan Sulfuric Polyester/)

CAB Abstracts 1910 to Present using the OVID interface

(cat.mp. OR cats.mp. OR feline.mp. OR felines.mp. OR felis.mp. OR exp cats/)

AND

(FLUTD.mp. OR cystitis.mp. OR lower urinary tract.mp. OR urological syndrome.mp. OR urologic syndrome.mp. OR FUS.mp. OR FIC.mp. OR exp urinary tract diseases/)

AND

(GAG.mp. OR GAGs.mp. OR glycosaminoglycan.mp. OR glycosaminoglycans.mp OR pentosan polysulphate.mp. OR pentosan polysulfate.mp. OR elmiron.mp. OR glucosamine.mp. OR glucosamines.mp. OR cystaid.mp. OR cystease.mp. OR exp glycosaminoglycans/ OR exp glucosamine/ OR exp pentosans/)

Search Outcome

MEDLINE

  • 18 papers found in MEDLINE search
  • 17 papers excluded as they don't meet the PICO question
  • 0 papers excluded as they are in a foreign language
  • 0 papers excluded as they are review articles/in vitro research/conference proceedings
  • 1 total relevant papers from MEDLINE

CAB Abstracts

  • 27 papers found in CAB search
  • 15 papers excluded as they don't meet the PICO question
  • 0 papers excluded as they are in a foreign language
  • 11 papers excluded as they are review articles/in vitro research/conference proceedings
  • 1 total relevant papers from CAB

Total relevant papers

1 relevant papers from both MEDLINE and CAB Abstracts

Comments

A second paper by Panchaphanpong et al. (2011) was identified, but excluded as the study examined blood and urine parameters only and did not look at clinical efficacy.

Summary of Evidence

Gunn-Moore & Shenoy (2004), United Kingdom

Title: Oral glucosamine and the management of feline idiopathic cystitis
Patient group: Forty cats visiting a referral practice with a history of recurrent dysuria, pollakiuria and haematuria. Twenty cats received 125mg N-acetyl glucosamine daily by mouth and twenty cats received placebo daily by mouth for 6 months.
Study Type: Randomised controlled trial
Outcomes:
  • Urine specific gravity
  • The health score: the severity of cats' clinical signs at start and end of study, as graded by owners on a scale of 0 (very severe cystitis) to 5 (normal cat)
  • Record of daily 'cystitis events' recorded by owner using visual analogue scales for each clinical sign
  • Monthly 'clinical score' based on the mean number of 'cystitis events' per cat per month in each group
Key Results:
  • No significant differences were noted between the two groups in terms of mean health score, monthly clinical score or the mean number of days with clinical signs 
  • Health score of both groups improved significantly over the study 
  • Urine specific gravity at start of trial was higher than at the end of the study in cats of both groups
  • Recurrence occured in 26 (65%) of the 40 cats
  • Two cats (both in the placebo group) were euthanased during the study, due to severe recurrent urethral obstruction  
Study Weaknesses:
  • All cases were referred to a specialist centre; therefore these cases may not representative of the general population.
  • The sample size was relatively small (n=40); however the chances of a Type II error (false negative) were calculated to be less than 10%.
  • The raw data are not present and missing data/loss to follow up are not fully described.
  • The methods are not described in sufficient detail to allow the study to be repeated.
  • Subjective scores were used which may lead to measurement bias; no validation/reliability studies of the scoring systems used were reported.
Attachment:
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Comments

There are limited data on the effectiveness of oral glycosaminoglycans or their precursors for the treatment of idiopathic cystitis, with no significant differences in clinical signs identified between the treatment and placebo groups. The limited number of patients means that the study may have been underpowered, so it is possible that any actual differences between the two groups were not identified. 

 


Bottom line

There is no evidence to suggest that oral glycosaminoglycans or their precursors are effective in reducing clinical signs in cats with non obstructive lower urinary tract disease.

Disclaimer

The BETs on this website are a summary of the evidence found on a topic and are not clinical guidelines. It is the responsibility of the individual veterinary surgeon to ensure appropriate decisions are made based on the specific circumstances of patients under their care, taking into account other factors such as local licensing regulations. Read small print

References

Gunn-Moore DA, Shenoy CM, (2004). Oral glucosamine and the management of feline idiopathic cystitis. Journal of Feline Medicine and Surgery 6: 219-25.


Panchaphanpong J, Asawakarn T, Pusoonthornthum R, (2011). Effects of oral administration of N-acetyl-D-glucosamine on plasma and urine concentrations of glycosaminoglycans in cats with idiopathic cystitis.  American Journal of Veterinary Research 72: 843-50

About this BET

First author:
Martin Downes
Second author:
Natalie Robinson
Institution:
CEVM, University of Nottingham
Search last performed:
2015-04-13 14:45:52
Original publication date:
2015-04-24 14:45:52
Last updated:
2015-04-24 14:45:52
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