Use of Deoxycorticosterone Pivalate by Veterinarians: A Western European Survey.

Rita Rebocho,Maria Pérez-Alenza,Andrea Corsini,Rodolfo Leal,Ryane Englar,Marina Domínguez-Ruiz,Michael Bennaim,Carolina Arenas,Federico Fracassi

doi:10.3390/vetsci8110271

Abstract

This study aims to gather knowledge about the use of deoxycorticosterone pivalate (DOCP) by Western European Veterinarians (WEV) in dogs with typical hypoadrenocorticism. An observational cross-sectional study was conducted using an online survey, translated into four languages and disseminated to veterinary affiliates and mailing lists in six countries of Western Continental Europe. Respondents were tasked to share their therapeutic approach to hypoadrenocorticism, whether they preferred DOCP or fludrocortisone and the specific practical use of DOCP. One-hundred and eighty-four responses were included. Of these, 79.9% indicated that they preferred prescribing DOCP over fludrocortisone as a first-line treatment for mineralocorticoid supplementation. A total of 154 respondents had used DOCP at least once. Eighty percent of those who reported their initial dosage prescribed 2.2 mg/kg. After starting DOCP, 68.2% of the respondents assess electrolytes 10 and 25 days after administration following manufacturer instructions. In stable dogs, electrolytes are monitored quarterly, monthly, semi-annually, and annually by 44.2%, 34.4%, 16.9%, and 4.6% of respondents respectively. When treatment adjustment is required, 53% prefer to reduce dosage while 47% increase the interval between doses. Overall, DOCP is the preferred mineralocorticoid supplementation among WEV. Reported variability underlies the need to investigate the best strategies for DOCP use and therapeutic adjustments.

Highlights

Hypoadrenocorticism is not commonly reported in companion animal practice, with an incidence of 2.3 cases per 10,000 dogs [1]
This study aims to gather knowledge about the administration of deoxycorticosterone pivalate (DOCP) by Western European Veterinarians (WEV) in dogs with typical hypoadrenocorticism
DOCP should be systematically associated with glucocorticoid supplementation meaning that single-agent therapy with DOCP can be life-threatening for dogs with typical hypoAC [3,7]

Summary

Introduction

Hypoadrenocorticism (hypoAC) is not commonly reported in companion animal practice, with an incidence of 2.3 cases per 10,000 dogs [1]. The combination of subcutaneous injectable DOCP dosed approximately every 25–30 days and daily glucocorticoid supplementation is prescribed by many clinicians to manage hypoAC in dogs. This combination rapidly restores the sodium:potassium ratio, resolves clinical signs, and is easier to dose-adjust for mineralocorticoid replacement due to the absence of glucocorticoid activity [4,5,6,7,8,9]. In 2015, a new formulation of DOCP was approved by the European Medicines Agency [11] This formulation was subsequently commercialized in the United States in 2016. Fludrocortisone must be prescribed off-label to treat dogs with hypoAC because there is currently no veterinary formulation

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