Octreotide for Lymphangiectasia in Dogs

In the Literature

Jablonski SA, Mazepa ASW, Tolbert MK. Use of octreotide for the treatment of protein-losing enteropathy in dogs: retrospective study of 18 cases. J Vet Intern Med. 2024;38(1):145-151. doi:10.1111/jvim.16966

The Research … 

Lymphangiectasia is a common cause of protein-losing enteropathy, in which small intestinal lymphatic vessels become dilated, inflamed, and/or obstructed, resulting in focal, segmental, or diffuse lymph leakage and protein loss. Certain dog breeds are genetically predisposed to developing lymphangiectasia in the absence of inflammation, while others acquire lymphatic obstruction secondary to chronic inflammatory enteropathy, intestinal lymphoma, or other intestinal diseases.¹

Lymphangiectasia treatment is focused on reducing lymphatic flow and inflammation (if present), largely by feeding a low- to ultralow-fat diet to reduce lymphatic pressure. Dogs with lymphangiectasia secondary to chronic inflammatory enteropathy may also require a novel or hydrolyzed dietary protein, corticosteroids, and immunosuppressive agents to reduce lymphatic inflammation and any immune component of disease.² Despite these and other adjunctive therapies, ≈50% of dogs with protein-losing enteropathy succumb to the disease.¹ Additional therapies are thus desirable.

This retrospective, multicenter study evaluated whether treatment with octreotide, a somatostatin analogue, resulted in clinical improvement and improved serum cholesterol and albumin concentrations in dogs in which traditional lymphangiectasia therapy was not successful. It has been hypothesized that octreotide may improve outcomes by reducing chyle and lymphatic pressure within intestinal lymphatics.³

Of 18 dogs that received octreotide as an adjunctive treatment, 12 did not have additional treatment adjustments before re-evaluation after a median of 21 days. Half of the 12 dogs showed clinical improvement, noted as improved stool consistency (4/6), increased activity (2/6), improved appetite (2/6), and decreased peritoneal effusion (1/6). All 6 dogs that responded to therapy had increased serum cholesterol concentrations, and 5 had increased serum albumin concentrations. Of the 6 dogs that did not respond clinically to octreotide, 3 had increased serum cholesterol concentrations, and 1 had increased serum albumin concentration.

Dogs that responded clinically to octreotide received a median daily dose of 30 µg/kg SC, divided and given every 8 or 12 hours, and dogs that did not respond received a median daily dose of 20 µg/kg SC, divided and given every 8 or 12 hours. Adverse effects were minimal in all dogs that received octreotide, with 1 dog showing signs of pain at the injection site and 2 dogs developing urgent diarrhea within 30 minutes of octreotide injection.

… The Takeaways

Key pearls to put into practice:

• This study demonstrated that octreotide (30 µg/kg SC, divided and given every 8 or 12 hours) can be administered safely. A prospective, blinded, and controlled study is necessary before octreotide can be determined effective for treatment of lymphangiectasia in dogs.

• Octreotide may be considered as an adjunctive treatment for lymphangiectasia but should not be used alone. Feeding a low- to ultralow-fat diet remains the cornerstone of therapy. Anti-inflammatory, immunomodulatory, and other adjunctive therapies may also help manage this disease.