Cyclosporine Tapering: Successful Practices

Daily administration of cyclosporine at 7 mg/kg is efficacious for allergy-induced pruritus in cats; however, little is known about tapering this to the lowest dose necessary to control pruritus. Eighty-eight cats with hypersensitivity dermatitis received 4 weeks of cyclosporine at 7 mg/kg PO q24h. Dose tapering schedules were every other day and twice weekly. After the 4-week induction period at 7 mg/kg, the dose could be tapered to every other day in 70% of cats while still maintaining clinical remission. Up to 57% could have the dose tapered to twice weekly. The less frequent administration was associated with fewer adverse effects. The most common adverse effects were GI-related, but these were mild and did not require medical intervention. There was a trend toward transient weight loss (attributed to transient GI disturbance), but all cats regained their weight at the study’s end.

CommentaryEven if the underlying trigger of allergic dermatitis is identified, humane relief of pruritus is necessary. The most widely used drugs for this are glucocorticoids and cyclosporine. Veterinarians, well acquainted with dose tapering of glucocorticoids, could benefit from this study’s information on cyclosporine dose tapering. The optimal treatment protocol is cyclosporine at 7 mg/kg PO q24h for 30 days before considering dose taper, then gradually tapering the dose to every other day for several weeks. If the cat remains in remission, it is reasonable to attempt administering the drug twice weekly. When managing allergic cats, it is important to minimize possible flare factors. The two most common flare factors are ectoparasites (best managed by year-round flea and tick control) and recurrent microbial overgrowth (best managed by grooming hygiene). The need for daily baths is uncommon, but most cats with chronic allergic skin disease can benefit from some aid with grooming (ie, combing and brushing the coat) to help shed hairs and disperse skin oils.—Karen A. Moriello, DVM, DACVD

SourceDose tapering for ciclosporin in cats with nonflea-induced hypersensitivity dermatitis. Steffan J, Roberts E, Cannon A, et al. Vet Dermatol 24:315-322, 2013.