title: Retrospective evaluation of combined mycophenolate mofetil and prednisone treatment for meningoencephalomyelitis of unknown etiology in dogs: 25 cases (2005-2011).
abstract: OBJECTIVE
  To evaluate the use of a combined protocol of prednisone and mycophenolate mofetil (MMF) for the treatment of meningoencephalomyelitis of unknown etiology (MUE) and to describe response, adverse effects, and outcome.
  
  
  METHODS
  Retrospective study (2005-2011).
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  Twenty-five client-owned dogs with clinical signs, neuroimaging, and cerebrospinal abnormalities consistent with MUE. Five dogs whose MMF treatment was discontinued after 7-14 days due to gastrointestinal clinical signs were evaluated only for adverse effects.
  
  
  METHODS
  Dogs were initially treated with prednisone 2 mg/kg PO every 12 hours and with MMF 20 mg/kg PO or IV every 12 hours. Prednisone was tapered after 4 days to 1 mg/kg every 12 hours for 14 days, then to every 24 hours for 30 days, and again reduced by half every 2-4 months thereafter. When prednisone was tapered completely or to 0.5 mg/kg every 24-48 hours without clinical relapse, MMF was tapered in a similar manner.
  
  
  RESULTS
  Partial or complete clinical response was achieved in 95% (19/20) of the dogs. Median survival time by the end of the study was 250 days (range 6 to >1,679) with 40% (8/20) of the dogs still alive (336-1,679 days after diagnosis). All Pug dogs (4/20) included in the study died with a median survival time of 14 days. Adverse effects attributed to MMF, which included hemorrhagic diarrhea within the first 2 weeks of treatment, were recorded in 20% (5/25) of the dogs.
  
  
  CONCLUSIONS
  MMF can be used as an adjunctive treatment for dogs with MUE. This protocol enables reduction of prednisone treatment or, in some cases, its complete withdrawal. The possibility of intravenous administration is advantageous in cases with severe neurological abnormalities and mentation changes, often seen in MUE. Attention is warranted for gastrointestinal adverse effects, especially in the first 2 weeks of treatment.
authors.affiliation: Departments of Neurology, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, 76100, Israel.
authors.forename: Itai
authors.initials: I
authors.lastname: Barnoon
authors.affiliation: Departments of Neurology, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, 76100, Israel.
authors.forename: Merav H
authors.initials: MH
authors.lastname: Shamir
authors.affiliation: Small Animal Internal Medicine, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, 76100, Israel.
authors.forename: Itamar
authors.initials: I
authors.lastname: Aroch
authors.affiliation: Teaching Services Unit, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, 76100, Israel.
authors.forename: Tali
authors.initials: T
authors.lastname: Bdolah-Abram
authors.affiliation: Departments of Neurology, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, 76100, Israel.
authors.forename: Itai
authors.initials: I
authors.lastname: Srugo
authors.affiliation: Departments of Neurology, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, 76100, Israel.
authors.forename: Lilach
authors.initials: L
authors.lastname: Konstantin
authors.affiliation: Departments of Neurology, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, 76100, Israel.
authors.forename: Orit
authors.initials: O
authors.lastname: Chai
mesh_terms: D000818:Animals; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D004283:Dog Diseases / Q000188:drug therapy*; D004285:Dogs; D004359:Drug Therapy, Combination; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008590:Meningoencephalitis / Q000188:drug therapy / Q000662:veterinary*; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D011241:Prednisone
keywords: CNS disease; MUE; canine; inflammatory brain disease; meningoencephalitis