Overall survival with beraprost in dogs with IRIS stage 2 chronic kidney disease

Chronic kidney disease (CKD) in dogs is a progressive condition with a poor prognosis and a lack of effective pharmacological interventions to extend survival. Beraprost, an oral prostacyclin analog approved for feline CKD, was off-label prescribed and evaluated for its effect on survival in dogs with naturally occurring IRIS stage 2 CKD. This prospective clinical study included a treatment group (n = 16) receiving oral beraprost (12.5 μg/kg twice daily), and a well-matched historical control group (n = 17) from the same institution. The primary outcome, overall survival, was analyzed using the Kaplan-Meier method and a multivariable Cox proportional hazards model. Baseline characteristics were largely comparable between the groups. Significantly longer survival was observed in the beraprost-treated group, with a median survival time of 1,101 days (a 5.6-fold increase), compared to 198 days in the control group (P = 0.001). Furthermore, beraprost therapy was associated with a significant delay in the time to secondary composite endpoints, including disease progression (to IRIS stage 3/4) or death (P = 0.001) and 10% body weight loss or death (P = 0.028), underscoring the robustness of the survival data. After adjusting for age and urine protein-to-creatinine ratio, beraprost treatment remained the sole independent predictor of improved survival (hazard ratio, 0.15; 95% confidence interval 0.03-0.79; P = 0.025). Although limited by its non-randomized design and small sample size, this study provides the first clinical evidence that oral beraprost is associated with a substantial benefit on overall survival in dogs with IRIS stage 2 CKD, supporting the need for large-scale randomized controlled trials.