A comparison of once and twice daily administration of trilostane to dogs with hyperadrenocorticism^[*]

Summary

Objective: This retrospective study describes the use of trilostane given once versus twice daily in dogs with hyperadrenocorticism (SID vs. BIDgroup) in separate clinical trials.

Material and methods: The groups were compared over a six month period using laboratory findings, dose required to suppress post-ACTH cortisol, and clinical scores from owner and clinician questionnaires.

Results: Ninety-three dogs enrolled the trials but for analysis of the final visit results only 56 dogs filled the inclusion criteria: 30 dogs in the SID-group and 26 dogs in the BID-group. Both treatment groups showed an improvement in clinical scores with time and no significant difference between them. In the BID-group post-ACTH cortisol concentrations went below 250 nmol/l sooner and in a higher proportion of dogs than in the SID-group.Twice-daily administration of trilostane also achieved a faster and more effective control for comparable daily doses. A higher individual tolerability (based on clinical scores) was found in the SID-group but there were no supporting laboratory findings. No dogs developed serious side-effects.

Conclusion: This study reveals only small practical differences between once and twice daily trilostane administrations in treating hyperadrenocorticism. And the overall benefits of twice daily dosing have to be considered against the effect on the owners and their compliance with treatment.

Zusammenfassung

Ziel: Die retrospektive Studie beschreibt den Einsatz von Trilostan bei Hunden mit Hyperadrenokortizismus (HAK) bei einmal bzw. zweimal täglicher Applikation (SIDbzw. BID-Gruppe) in unterschiedlichen klinischen Studien.

Material und Methoden: Die Gruppen wurden über einen Zeitraum von 6 Monaten mithilfe von Laborergebnissen, der benötigten Dosis zur Kortisolunterdrückung nach ACTH-Gabe und einer klinischen Punkteskala anhand eines Fragebogens für Patientenbesitzer und Tierärzte miteinander verglichen.

Ergebnisse: Dreiundneunzig Hunde nahmen ursprünglich an dem Versuch teil, aber nur 56 Hunde erfüllten die Einschlusskriterien für die Analyse des letzten Besuchs: 30 Hunde in der SID-Gruppe und 26 Hunde in der BID-Gruppe. Über den Untersuchungszeitraum ergab sich in beiden Behandlungsgruppen eine Verbesserung der Werte in der klinischen Punkteskala ohne signifikante Unterschiede zwischen den Gruppen. Die Kortisolkonzentrationen nach ACTH-Gabe in der BID-Gruppe sanken früher und in einem signifikant höheren Verhältnis als in der SID-Gruppe. Bei einer vergleichbaren gesamten Tagesdosis wurde mit der zweimal täglichen Applikation eine schnellere Kontrolle der klinischen Symptome erreicht. Obwohl die SID-Gruppe gemäß der klinischen Punkteskala eine bessere individuelle Therapietoleranz aufwies, ließ sich dies nicht durch Laborergebnisse bestätigen. Kein Hund entwickelte ernste Nebenwirkungen.

Schlussfolgerung: Die Studie offenbart kleine Unterschiede zwischen der einmal und zweimal täglichen Applikation von Trilostan bei der Behandlung von HAK. Wir kommen zu dem Schluss, dass die zweimal tägliche Behandlung mit Trilostan zu einer etwas schnelleren und effektiveren Kontrolle des HAK führt, aber bei einer vergleichbaren gesamten Tagesdosis mit einem etwas höheren Risiko von Nebenwirkungen einhergeht. Die Gesamtvorteile der zweimal täglichen Applikation erfordern eine gute Compliance der Patientenbesitzer.

Key words

Hyperadrenocorticism - dogs - trilostane treatment

Schlüsselwörter

Hyperadrenokortizismus - Hunde - Trilostanbehandlung

^* This study was previously presented in abstract form at the Congress of the European College of Veterinary Internal Medicine (ECVIM) – Sept. 2008.

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