It really depends on who you talk to. The use of corticosteroids in veterinary medicine can be a blessing or a curse. A wise old veterinarian once shared with me that “although antibiotics may be the heart of your practice, steroids are its soul”. But we also must heed the lyrics of Barry White when he once shared “too much of anything isn’t good for you baby”. Perhaps the answer lies in-between: judicious situational usage is the key when discussing corticosteroids.
In the trade journal DVM 360 this past month, Daniel Fletcher, PhD, DVM, DACVECC shared with us that the acronym “CIA” was an easy way to justify the use of corticosteroids in the veterinary patient. For definition purposes, think of any anti-inflammatory drug ending in –one, like dexamethasone, prednisone, prednisolone, triamcinolone and the like (but not hormones or anabolics like testosterone). With this in mind, what is the “CIA” advice about? Let’s take a look:
C-Cancer. We all know that although corticosteroids don’t kill cancer cells, they serve many ancillary purposes in the cancer patient. They help with associated secondary inflammation, can stimulate the appetite in the anorexic patient, and give a sense of well-being through at least palliative therapy. Even when chemotherapy is in play, corticosteroids have a role in the overall treatment plan.
I-Immune-mediated disease. Corticosteroids are at the heart of the treatment on immune-mediated thrombocytopenia, autoimmune hemolytic anemia and the autoimmune skin diseases. No ifs ands or buts on this.
A-Actually, Fletcher calls them the “Five A’s”. Atopy, asthma, anaphylactic shock, Addison’s disease and allergies. I’ll say that whenever confronted with any of these five situations, I have reached for corticosteroids in the past. However, on that last “a”, there are more alternatives as opposed to corticosteroids in recent years. Some of these newer antihistamines have changed the game regarding the use of so many corticosteroids on “itchy skin”. The often-reported side-effects, like drinking excessive water and excessive urination can discourage pet owners and veterinarians alike from choosing this option so quickly. So have innovative diets, like Hill’s Derm-Defense food, a new player in specific realm of canine atopy.
Beyond these categories, veterinarians have to be careful in situations like gastroenteritis, trauma, back problems and heat stroke. Many veterinarians are on the fence when corticosteroid usage is discussed when treating snake bites. While many have justified the use of corticosteroids in many of these emergency-type situations, longer-term repercussions, like immunosuppression must be thought through.
In my experience, the benefits versus the risk in an individual situation must be weighed out. In my 33 years of practice, I have seen some wonderful results as a result of corticosteroid usage. However, I have seen a few disasters as well. Most importantly, the choice to use corticosteroids in marginal situations must be offered and accepted as part of the therapy by the pet owner. In that manner, the veterinarian and the pet owner are in partnership on the decision as whether to treat the pet with or without corticosteroids.
The bottom line? Begin with “CIA” in mind!
Have a great week with your pets!
Dr. Chris Duke