01390-A: The Use of Mycophenolate in the Treatment of Primary Immune Mediated Hemolytic Anemia

Project Summary

Immune mediated hemolytic anemia (IMHA) is an autoimmune condition caused by the body attacking its own red cells. Approximately 1 in every 3 affected dogs die from the disease or its complications (either naturally or through humane euthanasia). The mainstay of treatment is suppression of the immune system to stop the destruction of the red cells; this typically involves the use of prednisone (a corticosteroid) and a second immunosuppressive medication. However, the most effective treatment strategy remains unknown. Mycophenolate is an immunosuppressive drug used in human medicine for autoimmune diseases and prevention of rejection of liver or kidney transplants. It is currently being used with increasing frequency in veterinary medicine for the treatment of autoimmune conditions, including IMHA. The purpose of this study was to report the use of mycophenolate in the treatment of naturally occurring IMHA in client owned animals while providing additional standard of care therapies (blood transfusions, prednisone, low dose aspirin for clot prevention, and symptomatic therapies). The goal was to determine if the use of mycophenolate in the treatment protocol appears to have a benefit and if further studies investigating the use of this drug are warranted. In 18 months, the reserachers were able to enroll five patients in their study meeting the study criteria. Although true efficacy cannot be assessed in the absence of a control group, the findings suggest that mycophenolate can be used in combination with prednisone in the treatment of IMHA. Close monitoring of cell counts, liver values, and kidney function have revealed no major adverse effects. The most common adverse effect noted has been diarrhea which can be severe in some patients, particularly if combined with vomiting and loss of appetite. Future studies are indicated to evaluate mycophenolate's efficacy in comparison to other commonly used immunosuppressants, such as cyclosporine, and to better understand the associated gastrointestinal adverse effects.

Publication(s)