Feline pemphigus foliaceus in non-specialist veterinary practice: a retrospective analysis

To characterise the signalment, clinical presentation and therapy of pemphigus foliaceus in cats treated by primary care practitioners.

Retrospective evaluation of patient and treatment factors with the following case outcomes: remission (achieving remission, time to remission), treatment-related adverse effects (number, severity) and final disease outcome (medical control, cure, death or euthanasia).

Data were obtained from 48 cats with biopsy-confirmed pemphigus foliaceus managed by practitioners from six countries and 47 hospitals. Clinicians prescribed oral prednisolone most commonly for immunosuppression (median dose 2·2 mg/kg/day). Disease remission information was available in 40 cats; 90% achieved disease remission, which did not appear related to the doses of oral glucocorticoid administered in this study. Disease relapse occurred in 29 (73%) cats after achieving remission, necessitating medication adjustments. Severe treatment-related adverse effects occurred in eight cases, including both cats treated with long-acting injectable glucocorticoids. Of 31 cats treated with glucocorticoid monotherapy, 27 achieved remission, as did eight of 11 ciclosporin plus glucocorticoid-treated cats. Eleven cats experienced adverse effects: five receiving ciclosporin plus glucocorticoid and six receiving glucocorticoid monotherapy.

Pemphigus foliaceus remission with treatment is highly likely in cats but relapse is common, necessitating close monitoring and individualised therapy modifications. Clinicians should focus on the judicious use of glucocorticoids to minimise treatment-related adverse effects, such as avoiding injectable glucocorticoids, combining glucocorticoids with steroid-sparing medications, and regularly rechecking patients to adjust drug dosages in response to disease status.