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Oral treatment with interferon omega versus steroids in cats with chronic gingivostomatitis

Clinical Scenario

Sylvester is a 10 year old male neutered British Shorthair cat belonging to Mrs Bassett. Sylvester has been having problems with chronic gingivostomatitis for over 9 months. You have given repeated courses of antibiotics and NSAIDs and have just removed all of his teeth except for his canines - he still has signs. You are running out of options and considering using steroids as he has had depomedrone once before and the effect was dramatic. Mrs Bassett is on many medications herself including corticosteroids with which she has many side effects. She is very reluctant to give them to Sylvester long term as she doesn’t want him to suffer in a similar way. She has just been reading about the use of interferons in a cat magazine that reports its use in a cat which then got completely better. She wants to know if it will help her cat and help avoid steroids. You wonder if there is any evidence comparing interferon (IFN) with steroid use in chronic feline gingivostomatitis...

3-Part Question (PICO)

In [cats with chronic gingivostomatitis] does the [use of oral interferon omega compared to oral steroids] [decrease the clinical signs of disease more rapidly]?

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 felidae.mp. OR exp Cats/ OR exp Felidae/)

AND

(stomatitis.mp. OR gingivostomatitis.mp. OR palatoglossitis.mp. OR buccostomatitis.mp. OR fcgs.mp. OR exp Stomatitis/)

AND

(interferon.mp. OR interferons.mp. OR steroid.mp. OR steroids.mp. OR corticosteroid.mp. OR corticosteroids.mp. OR corticoid.mp. OR corticoids.mp. OR exp Interferons/ OR exp Steroids/)

CAB Abstracts 1910 to Present using the OVID interface

(cat.mp. OR cats.mp. OR feline.mp. OR felines.mp. OR felidae.mp. OR exp cats/ OR exp Felidae/)

AND

(stomatitis.mp. OR gingivostomatitis.mp. OR palatoglossitis.mp. OR buccostomatitis.mp. OR fcgs.mp. OR exp stomatitis/)

AND

(interferon.mp. OR interferons.mp. OR steroid.mp. OR steroids.mp. OR corticosteroid.mp. OR corticosteroids.mp. OR corticoid.mp. OR corticoids.mp. OR exp interferon/ OR exp steroids/ OR exp corticoids/)

Search Outcome

MEDLINE

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

CAB Abstracts

  • 53 papers found in CAB search
  • 45 papers excluded as they don't meet the PICO question
  • 2 papers excluded as they are in a foreign language
  • 5 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

Summary of Evidence

Hennet et al. (2011) Carried out in Belgium, France, Germany, Spain and Switzerland

Title:

Comparative efficacy of a recombinant feline interferon omega in refractory cases of calicivirus-positive cats with caudal stomatitis: a randomised, multi-centre, controlled, double-blind study in 39 cats.

Patient group:

39 feline calicivirus-positive cats with refractory feline gingivo-stomatitis

Study Type:

Randomised controlled trial

Outcomes:
  • Weight
  • Behavioural measures: appetite, pain, salivation, activity
  • Pain on opening mouth
  • Halitosis
  • Lymphomegaly
  • Lesion scoring
  • Outcomes measured on D0, D15, D30, D60 and D90
Key Results:
  • No difference in change in body weight between treatments
  • Both groups showed improvement in some behavioural measures over time
  • Pain on opening mouth scores lower in interferon (IFN) vs prednisolone on D60 and D90 (p=0.017 and p=0.007 respectively)
  • Some decrease in halitosis in both groups at different time points
  • Lesion scores improved in both groups
  • No significant difference in overall response to treatment between groups
  • 8 cats in the IFN group and 9 in the prednisolone group required rescue medication (butorphanol, meloxicam or clindamycin)
Study Weaknesses:
  • Small group size
  • No power/sample size calculation
  • Possible missing data as 9 cats (out of 39) were withdrawn and it is not clear whether their data were included or not in many parts of the analysis
  • Many statistical tests performed without allowing for missing data
  • Prednisolone given for a much shorter time than IFN
  • Very strict case criteria may limit external validity—but also may improve internal validity
Attachment:
No attachments.

Comments

This is a small study, and results must be interpreted with caution, particularly as the control (prednisolone) was only given for 21 days whereas the study drug was given for 90 days.

Interferon treatment may be worth considering in cases of refractory feline chronic gingivostomatitis. However in clinical practice, the real question would probably be how do cats do with both IFN and steroids?

This study was funded by Virbac, manufacturers of omega interferon.

Bottom line

Both prednisolone and oromucosal interferon were associated with a clinical improvement in affected cats. However it is not possible to conclude from this study which treatment is preferable.

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

Hennet PR, Camy GAL, McGahie DM, Albouy MV (2011) Comparative efficacy of a recombinant feline interferon omega in refractory cases of calicivirus-positive cats with caudal stomatitis: a randomised, multi-centre, controlled, double-blind study in 39 cats. Journal of Feline Medicine and Surgery 13: 577-587.

About this BET

First author:
Jenny Stavisky
Second author:
Rachel Dean
Institution:

CEVM, University of Nottingham

Search last performed:
2016-03-02 09:28:08
Original publication date:
2013-09-13 09:28:08
Last updated:
2016-03-02 09:28:08
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