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Attn Dr Kellon - Question re: Cyclosporine implants for PPID horses
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Hello Dr Kellon,
What information to you have about PPID/IR horses receiving a long term immunomodulator, such as cyclosporine, as an implant to treat ERU, long term? Would you recommend for or against such a procedure and are there other treatments considered safer for a horse with PPID/IR? I have heard both sides of the equation, safe and not safe, with more opinions leaning towards "not safe" for PPID/IR horses - and that would be because the horse would already be considered immune compromised and cyclosporine could aggravate the condition. Thanks for any information! -- Sue R in NC 2021 CASE HISTORY: https://ecir.groups.io/g/CaseHistory/files/Sue%20and%20Shifty |
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HI Sue
Not sure if this answers your specific questions. Here's a review of the drug in the archives. https://ecir.groups.io/g/main/search?p=created%2C0%2C%2C1%2C2%2C0%2C0&q=Cyclosporine -- Nancy C in NH ECIR Moderator 2003 ECIR Group Inc. President 2021-2022 HOW TO SEARCH THE ARCHIVES: https://ecir.groups.io/g/main/wiki/1993 |
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Sue, I just typed 'cyclosporine' in the search box and there are quite a few message threads on the topic, or that mention the medication. You might find useful info there as well.
-- Maxine and Indy (PPID) and Dangles (PPID) Canberra, Australia 2010 https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles
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Thank you all very much. From what I get from the comment history, cyclosporin use can be considered at your own risk and that of your vet. Since PPID/IR horses already are immunosuppressed, that should be a consideration before signing on to treatment and, as Dr Kellon recommends, thorough examination for any fungal remnants should be considered before eliminating any other, possibly more appropriate treatments to address ERU in immune compromised equines?? Is that it in a nutshell??
-- Sue R in NC 2021 CASE HISTORY: https://ecir.groups.io/g/CaseHistory/files/Sue%20and%20Shifty |
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It's evidence of active leptospira infection that needs to be checked. That's a bacterium. Blood titers can be done two weeks apart. If no evidence of active infection and no evidence of any other cause, the implant is a reasonable choice in chronic cases that fit the criteria, including having no posterior chamber or retinal signs. PhytoQuench pellets can be very helpful in reducing the need for medication.
Do you have any more recent ACTH or TRH stimulation results? Does he have any signs of being immunocompromised? If his PPID is well controlled, I personally would consider the implant if his uveitis could not be controlled. -- Eleanor in PA www.drkellon.com BOGO 2 for 1 Course Sale Through End of January |
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Thanks so much for your reply Dr Kellon. I ask for a friend who, unfortunately, has started the ERU journey with her horse, who also has been recently diagnosed with PPID. I went through this last year with my own PPID TBred, (his info was in the chart you viewed) and was given a very good prognosis and treatment for lepto infection ERU. I did did the topical options at first but because of the posterior chamber involvement, the gent injections were recommended and used, very successfully. Rechecks show complete clearing, posterior and anterior, and with his PPID coming under much better control (although it is still high and I will be re-testing again after seasonal rise), we have not had any flares. Since the implants were not a good option for me, the specialist didn't go into much about them with me. My friend, however, is being offered the implants, but her horse has been diagnosed as having ERU by a different cause and the horse's PPID is nearly under control, or will be by the time she does the implants. She was not sure why she was not given the gent injection options. I understand the differences that were under consideration for my case now and why the gent treatment was successful for us. My friend has a bit of a different situation under consideration for her horse and I am hopeful she will have a positive outcome, as well. They'll just arrive there using a different option because of the patient's different conditions. For anyone going down the ERU road with a horse who is also PPID I can only say act fast to understand and approach the situation with a plan of action, enlist your vet AND an equine ophthalmologist. Your chances of getting a great outcome are ten fold and, as you say, Dr Kellon, if you start out wanting the wisdom by saying, "I don't know"!!! Thank you, again!
-- Sue R in NC 2021 CASE HISTORY: https://ecir.groups.io/g/CaseHistory/files/Sue%20and%20Shifty |
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Dr. Kellon. My Yoyo (an Appy) lost one eye to advanced ERU (removed in 2018) and now diagnosed with early stage ERU in his remaining eye. He has very limited vision which is decreasing and he doesn't seem to be in much pain yet. I chose not to have the cyclosporine implant, instead am administrating a gel- "Triple antibiotic w/Dexamethasone" every other day. In one of your replies to Sue, you commented that "PhytoQuench pellets can be very helpful in reducing the need to medication." I've been meaning to ask you if Devils Claw could help my horse with the pain/advancement of the ERU and this subject thread opened up that possibility. Yoyo also has recurring cancer on his penis. I'm assuming his is immunocompromised, correct? Note- he also was diagnosed with Congenital Night Blindness. (This not found until this year at age 19, even with prior eye exams by ophthalmologists. I don't understand why not found years ago, but that's a whole other issue).
-- Ronelle and Yoyo 2015 Bend, Or, US |
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Appaloosas are prone to both ERU and SQC so can't really blame them on PPID immunosuppression. It's worth trying the PQ.
-- Eleanor in PA www.drkellon.com BOGO 2 for 1 Course Sale Through End of January |
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