Dr Duval is presently affiliated with Georgia Veterinary Specialists, Atlanta, GA.
Cyclophosphamide Exerts No Beneficial Effect over Prednisone Alone in the Initial Treatment of Acute Immune-Mediated Hemolytic Anemia in Dogs: A Randomized Controlled Clinical Trial
Article first published online: 28 JUN 2008
© 2003 American College of Veterinary Internal Medicine
Journal of Veterinary Internal Medicine
Volume 17, Issue 2, pages 206–212, March 2003
How to Cite
Mason, N., Duval, D., Shofer, F. S. and Giger, U. (2003), Cyclophosphamide Exerts No Beneficial Effect over Prednisone Alone in the Initial Treatment of Acute Immune-Mediated Hemolytic Anemia in Dogs: A Randomized Controlled Clinical Trial. Journal of Veterinary Internal Medicine, 17: 206–212. doi: 10.1111/j.1939-1676.2003.tb02435.x
A preliminary account of this study was presented at the annual ACVIM Forum in May 1997 in Orlando, FL (J Vet Intern Med 1997;11:130)
- Issue published online: 28 JUN 2008
- Article first published online: 28 JUN 2008
- Revised August 12, 2002 Accepted October 4, 2002.
- Autoimmune hemolytic anemia;
- Prospective comparative therapeutic study
Cyclophosphamide is commonly used with prednisone in the initial treatment of severe idiopathic immune-mediated hemolytic anemia (IMHA) in dogs because retrospective reports suggest its benefit. This randomized controlled prospective clinical trial evaluated whether combined cyclophosphamide and prednisone therapy is more efficacious than prednisone therapy alone in the initial treatment of IMHA. Eighteen dogs with acute, severe idiopathic IMHA were randomly assigned to 1 of 2 treatment groups. The P group received prednisone therapy alone (1–2 mg/kg PO q12h), and the PC group received prednisone (1–2 mg/kg PO q12h) and cyclophosphamide (50 mg/m2 PO q24h for 4 consecutive days a week) for 4 weeks. The mortality rate in the P group was 20% (2 of 10), and in the PC group, the mortality rate was 38% (3 of 8). There was no difference in sequential CBC evaluations between the 2 groups. However, whereas dogs in the P group showed increases in reticulocyte count, reticulocytosis was suppressed in dogs in the PC group during the 1st week of therapy. Spherocytosis resolved more quickly in the P group (day 21) than in the PC group (day 28), but the time taken to achieve a negative Coombs' test result was comparable between groups. No difference was observed in the volume of packed red blood cells (pRBCs) given per transfusion between treatment groups, but more dogs in the PC group required a 2nd transfusion. The results of this limited study suggest that cyclophosphamide plus prednisone has no benefit over prednisone alone in the initial treatment of acute, severe idiopathic IMHA in dogs.