Evaluation of client perceptions concerning outcome of cataract surgery in dogs

OBJECTIVE: To compare client perception of outcome of phacoemulsification in dogs with information obtained from medical records. DESIGN: Retrospective cohort study. ANIMALS: 108 dogs (203 eyes) undergoing phacoemulsification from May 1999 through April 2004. PROCEDURE: Data obtained from medical records included signalment, presence of diabetes mellitus, cataract stage, whether surgery was unilateral or bilateral, intraocular lens (IOL) placement, and postoperative complications. Owners completed a survey concerning outcome of phacoemulsification in their dog. Survey responses from owners classified as satisfied or dissatisfied with the outcome of phacoemulsification on the basis of their willingness, in retrospect, to have the surgery performed again were compared. RESULTS: Data from medical records and survey responses were available for 108 dogs (203 eyes). Median follow-up was 3 months via medical record review and 12 months via owner survey responses. Most (81%) owners were satisfied with outcome. The most common reason for dissatisfaction was loss of vision after surgery; however, most dissatisfied owners did not return their dog for examinations. Owner perception of success was not associated with patient age, sex, presence of diabetes mellitus, cataract stage, or IOL placement in at least 1 eye but was associated with perceived improvement of their pet's vision and activity level. Dissatisfied owners were significantly more likely to report that explanation of risks and complications before surgery was inadequate. CONCLUSIONS AND CLINICAL RELEVANCE: Owner perception of outcome after phacoemulsification in dogs was highly favorable. However, surgical risks and the importance of postoperative examinations, particularly in dogs undergoing visual deterioration, must be conveyed to clients.     

Perceptions of Quality of Life and Priorities of Owners of Cats with Heart Disease

Background: Owners' perceptions and priorities regarding quality of life (QoL) are important considerations given the unknown efficacy of many commonly administered medications, stress of hospital visits, difficulties providing home care, and personal choices including euthanasia. Objective: To describe the relative importance of quality versus quantity of life to owners of cats with heart disease. Animals: Two hundred and thirty‐nine cats with heart disease. Methods: Prospective questionnaire‐based clinical study. Cat owners completed a questionnaire to identify important parameters when assessing their cat's QoL, the relative importance of quality versus quantity of life, and willingness to trade survival time for QoL. Variables associated with these parameters were evaluated with multivariate analyses. Results: Appetite, owner interaction, sleep patterns, and litterbox habits were deemed important to QoL. Concern over pet suffering was significantly greater than concern over life expectancy. Ninety‐three percent of owners were willing to trade survival time for good QoL; 57% of these were willing to trade up to 6 months. On multivariate analysis, the only factor significantly (P= .002) associated with willingness to trade 6 months was study site. Owner concern regarding stress of administering medications at home increased with number and frequency of medications. Conclusions and Clinical Relevance: These results indicated that QoL is more important to owners of cats with heart disease than longevity. The various priorities and concerns of cat owners should be taken into account in order to provide optimal care.     

Prednisolone is associated with an increase in serum insulin but not serum fructosamine concentrations in dogs with atopic dermatitis

The aim of this study was to assess the effects of a standard therapeutic protocol of prednisolone (Pred) on glucose homeostasis in atopic dogs and compare it with previously published data for ciclosporin A (CsA). The central aim of the study was to assess and compare the effects of standard therapeutic protocols of prednisolone (Pred) and ciclosporin A (CsA) on glucose homeostasis in dogs with atopic dermatitis (CAD). Both treatments significantly reduced the physical signs of CAD, as determined by the canine atopic dermatitis extent and severity index version 3 (CADESI-03) and the Edinburgh Pruritus Scale (EPS). Post-treatment plasma glucose concentrations were not significantly different in the two groups, but serum insulin concentrations were significantly higher following Pred therapy (P<0.05). Serum fructosamine concentrations were not significantly different pre- and post-treatment with Pred, although previous studies had shown that CsA treatment increased fructosamine concentrations (P<0.005). The two treatment groups were recruited in a similar timeframe, were numerically matched and there were no differences in CADESI-03 and EPS scores between the CsA and Pred groups either before or after treatment. Thus, both CsA and Pred treatment were associated with mild disturbances in glucose metabolism, but only CsA therapy resulted in a significant increase in fructosamine concentrations. This information may be relevant to clinicians when considering therapeutic options for dogs with atopic dermatitis which already have impaired glucose homeostasis.     

The effect of a spot-on formulation containing polyunsaturated fatty acids and essential oils on dogs with atopic dermatitis

Recent studies have shown that immunological aberrations and epidermal barrier defects could be important in the pathogenesis of canine atopic dermatitis (CAD) and that oral polyunsaturated fatty acids (PUFAs) might influence the epidermal barrier. The aim of this study was to evaluate the effects of a spot-on formulation containing PUFAs and essential oils on pruritus and lesions caused by CAD. Forty-eight privately owned dogs of different breeds, ages and genders diagnosed with atopic dermatitis were included in a randomized, double-blinded, placebo-controlled, multicentre clinical trial. Dogs were treated with a spot-on formulation containing PUFAs and essential oils or placebo on the dorsal neck once weekly for 8 weeks. Before and after the study, CAD extent and severity index-03 (CADESI-03) and pruritus scores were determined by veterinarians and owners, respectively.There was significantly more improvement in CADESI-03 and pruritus scores in the treatment group than in the placebo group (P = 0.011 and P = 0.036, respectively). Additionally, more dogs improved by at least 50% in CADESI-03 and pruritus scores in the treatment group than in the placebo group (P = 0.008 and P = 0.070, respectively). No adverse reactions were observed. The topical preparation containing PUFAs and essential oils was a safe treatment and beneficial in ameliorating the clinical signs of CAD.     

The efficacy of commercially available veterinary diets recommended for dogs with atopic dermatitis

The classical treatments for dogs with atopic dermatitis have traditionally been oral antipruritic drugs, allergen-specific immunotherapy and topical therapy. Fifty dogs with atopic dermatitis were included in this multicentred, double-blinded, randomized study to compare clinical response to an 8-week period of feeding one of three commercial veterinary foods marketed for dogs with atopic dermatitis (diets A-C) or a widely distributed supermarket food (diet D). Atopic dermatitis was diagnosed using Willemse's criteria and through the exclusion of differential diagnoses. Fourteen dogs were assigned to diet A and 12 dogs each to diet B, C or D. Flea and tick control using a monthly fipronil spot-on product was administered for a minimum of 4 weeks prior to inclusion in the study and during the study period. Evaluations were made monthly. These included lesion scores, using an established scoring system (canine atopic dermatitis extent and severity index, CADESI-03) and owner evaluation of pruritus level using a visual analogue scale. After 8 weeks on the new diets, there was a significant improvement in CADESI and pruritus scores with diet B (Wilcoxon test, P = 0.043 and paired t-test, P = 0.012, respectively), in pruritus scores with diet A (paired t-test, P = 0.019) and in CADESI scores with diet D (Wilcoxon test, P = 0.037). No significant changes were detected with diet C. Based on the results of this study, in addition to the conventional therapies, changing the diet of dogs with atopic dermatitis may be a useful adjunctive therapeutic measure.     

A randomized, double-blind, placebo-controlled study to evaluate the effect of EFF1001, an Actinidia arguta (hardy kiwi) preparation, on CADESI score and pruritus in dogs with mild to moderate atopic dermatitis

Canine atopic dermatitis (AD) is common and new therapies are beneficial. This multicentric, randomized, double-blind, placebo-controlled study tested the efficacy of Actinidia arguta (hardy kiwi) (EFF1001) in dogs with mild/moderate AD. The study was divided into two stages. Stage 1 lasted 6 weeks. In the first 2 weeks prednisolone [days 1–3: 0.2 mg/kg twice daily (BID), days 4–14: 0.2 mg/kg every other day (EOD)] was administered. Responsive dogs were placed on prednisolone 0.2 mg/kg EOD + assigned test article [either placebo or EFF1001 (30 mg/kg)] once daily for 4 weeks. Stage 1 responders were advanced to stage 2, which involved 4 weeks of just EFF1001. Clinicians scored lesions using Canine Atopic Dermatitis Extent and Severity Index (CADESI) and owners scored pruritus using a Pruritus Visual Analogue Scale. Seventy-seven dogs were enrolled, 76 were randomized on day 14, and 57 (57/76 = 75%) completed stage 1 (27 in EFF1001 and 30 in placebo). At the end of stage 1, 35 of 57 dogs (35/57 = 61%) responded (18 in EFF1001 and 17 in placebo) and advanced to stage 2. At completion of stage 1, CADESI scores did not significantly differ between groups while pruritus decreased in EFF1001 group and approached significance. At completion of stage 2, 19 dogs (19/35 = 54%) responded (15/19 = 79% had received EFF1001 and 4/19 = 21% placebo in stage 1). After completing stage 2, dogs placed on EFF1001 throughout the study were 3.5 times more likely to either maintain or improve scores than those that started it in stage 2. It is concluded that EFF1001 is beneficial adjunctive therapy after prolonged use.     

Determination of CADESI-03 thresholds for increasing severity levels of canine atopic dermatitis

To evaluate the extent and severity of skin lesions in clinical trials enrolling dogs with atopic dermatitis (AD), the International Task Force on Canine Atopic Dermatitis recently recommended the use of the third version of the CADESI. This version of the CADESI was found to exhibit acceptable content, construct, criterion, inter- and intraobserver reliability and sensitivity to change. The current study was aimed at determining optimal CADESI-03 cut-off points to separate AD severity categories for future clinical trials. One hundred and eight dogs with AD were selected based on current diagnosis standards. At one or more visits, clinicians subjectively rated the severity of AD as 'in remission', 'mild', 'moderate' or 'severe', and a CADESI-03 score was then determined. In all, 158 CADESI-03 values were recorded and divided among the four disease severity categories. Receiver-operating characteristics (ROC) curves were generated at increasing cut-off values to determine the benchmark that would offer optimal sensitivity and specificity between adjacent categories. Cut-offs of 16, 60 and 120 are proposed at the interface of remission, mild, moderate and severe categories, respectively. Proposed intervals therefore are: remission: 0-15; mild AD: 16-59; moderate AD: 60-119; and severe AD: >/= 120. This Task Force recommends that, whenever applicable and relevant, subgroup analyses of outcome measures, based on disease severity as determined with these cut-off CADESI-03 values, be preplanned for clinical trials enrolling dogs with AD. Such subgroup analyses could help determine whether specific interventions might be more effective in a particular subset of atopic dogs.     

Physiological effects of interactions between female dog owners with neuroticism and their dogs

The aim of this study was to investigate the physiological effects of the relationship between dog owners with neuroticism and their dogs using noninvasive procedures to measure urinary cortisol and heart rate variability (HRV). Owner personalities were tested via the NEO Five-Factor Inventory and this study focused only on the dimension of neuroticism with 12-item scales. The 24 participating owners and their dogs were randomly divided into experimental and control groups. Each participant and their dog stayed in the test room for 80 minutes. The behavioral test included 2 resting times (R1 and R2, respectively), 2 command-communication times, a separation time, and a free time. In the control group, the command-communication times were changed to noncommunication times. Each participant wore a chest heart rate transmitter and a wrist watch monitor (RS800CX; Polar Electro) during the experiment. HRV is a quantitative parameter of autonomic activity. The spectral analysis of HRV is divided into 2 major oscillatory components: the high-frequency (HF) domain, which reflects parasympathetic activity and the low-frequency (LF) domain, which reflects both sympathetic and parasympathetic activities. The LF to HF ratio reflects sympathetic activity. In the experimental group, the neuroticism scores showed a positive significant correlation with a change in the HF power and a negative correlation with the ratio of the change in the LF to HF ratio. No correlations were found in the control group. Next, all participants were divided into 2 groups according to the HRV in R1 and R2. One group included participants whose HF increased in R2, and the other included participants whose HF decreased in R2. The neuroticism scores were significantly higher in the experimental subjects whose HF increased in R2 than in those whose HF decreased in R2. High neuroticism scores indicate individuals that may be sensitive to daily stresses. Our results showed that a parasympathetic activation occurred in owners with high neuroticism scores 10 minutes after a command-communication interaction with their dogs. This suggests that daily command communication–based interactions with their dogs could improve the owner's health for the better.     

Development of a questionnaire to assess the impact of atopic dermatitis on health-related quality of life of affected dogs and their owners

Atopic dermatitis (AD) is a chronic or chronically relapsing human and canine skin disease that is known to affect the quality of life (QoL) of affected individuals. Several studies have been conducted to develop disease-specific questionnaires and assess QoL in parents of children with AD and in the children themselves. The severity of canine AD is however currently evaluated using only clinical and pruritus scores. Measurement of the QoL of affected dogs and their owners could therefore provide a new tool for assessing disease severity and treatment efficacy. Ninety-eight owners of AD-affected dogs were asked to complete two questionnaires aiming to evaluate the QoL of affected dogs and their owners on one hand and the relationship between them and their dog on the other hand. Statistical analyses were carried out in order to assess the validity of the questionnaires and to select relevant questions for future studies. These analyses resulted in the selection of 13 questions that could be used in further studies aiming at determining the QoL of affected animals and their owners.     

Sulphido-leukotriene production from peripheral leukocytes and skin in clinically normal dogs and house dust mite positive atopic dogs

Pathogenesis of canine atopy has not been completely elucidated. In humans, sulphido-leukotrienes (s-LT) play a role in atopy, and increased production of s-LT occurs in the skin and peripheral leukocytes after allergen challenge. The study population included 16 clinically normal and 13 atopic dogs. All atopic dogs had in common a positive reaction (4+) to the intradermal injection of house dust mite (allergen of reference). Blood samples and skin biopsies were collected. Sulphido-LT synthesis by peripheral leukocytes after stimulation was measured, and no statistically significant difference was found between clinically normal and atopic dogs. Sulphido-LT concentrations in skin samples from stimulated and unstimulated sites were measured, and no statistically significant difference was detected between clinically normal and atopic dogs or between lesional and nonlesional skin within the atopic group. Clinical signs of atopic dogs were graded by owners and no correlation was found between their severity and cutaneous concentrations of s-LT. In this study there was no increase in s-LT synthesis in atopic dogs.     

The glucocorticoid sparing efficacy of PhytopicaTM in the management of canine atopic dermatitis

This double-blind randomized placebo-controlled trial indicates that Phytopica™ can be an effective glucocorticoid sparing agent in canine atopic dermatitis (AD). Twenty-two dogs with perennial AD [Canine Atopic Dermatitis with Severity Index (CADESI-03) ≥ 60] were given 200 mg/kg Phytopica™ or an identical placebo in food once daily for 56 days. All dogs were initially given 0.4 mg/kg methyl-prednisolone once daily, which was then adjusted according to the daily pruritus score (0–100 mm visual analogue scale). The cumulative dose and pruritus score were lower in the Phytopica™ than the placebo group. There were statistically significant time and treatment effects for the methyl-prednisolone dose and pruritus score, but there were no significant differences between the Phytopica™ and placebo groups in the proportion of dogs that achieved a > 50% reduction in dose or pruritus scores at day 56; the mean CADESI-03 scores at days 0, 28 and 56; the numbers achieving >50% reduction in CADESI-03 at days 28 and 56; or in the owners' global efficacy score at days 28 and 56. Adverse events included diarrhoea (three Phytopica™ and one placebo treated dog), polyuria/polydipsia (three dogs in each group), and polyphagia, intermittent anorexia and panting (one dog each in the placebo group). None of these by themselves required withdrawal of treatment.     

Short-term prednisolone therapy has minimal impact on calcium metabolism in dogs with atopic dermatitis

Glucocorticoids (GCs) are a large group of drugs used to treat a range of inflammatory, autoimmune and neoplastic diseases in dogs. Glucocorticoids have been linked to disturbances in calcium metabolism and skeletal disorders in humans, yet their effects at therapeutically effective dosages in dogs with spontaneous diseases are poorly understood. Serum concentrations of calcium, phosphate, vitamin D metabolites and plasma concentrations of parathyroid hormone and ionised calcium together with urinary fractional excretion of calcium and phosphate, were measured in 16 dogs with atopic dermatitis before and 6weeks after standard dosage prednisolone treatment (0.93-1.06mg/kg) every other day after 7days of treatment with the same dosage once daily. The severity of their physical signs, as assessed by the canine atopic dermatitis extent and severity index version 3 (CADESI-03) and the Edinburgh Pruritus Scale (EPS), decreased in all dogs following prednisolone treatment. There was no significant difference in any of the biochemical parameters measured following prednisolone treatment. This study indicates that prednisolone, used at a therapeutically effective dose, has minimal impact on calcium metabolism in dogs with atopic dermatitis.     

Assessment of a correlation between Canine Atopic Dermatitis Extent and Severity Index (CADESI-03) and selected biophysical skin measures (skin hydration,pH, and erythema intensity) in dogs with naturally occurring atopic dermatitis

Atopic dermatitis is a common allergic skin disease in dogs. The aim of this study was to examine the possibility of a correlation between biophysical skin variables: skin hydration (SH), skin pH, and erythema intensity measured in 10 different body regions and both total Canine Atopic Dermatitis Extent and Severity Index (CADESI-03) and CADESI measured in a given region (CADESI L). The study was conducted using 33 dogs with atopic dermatitis. The assessment of the biophysical variables was done in 10 body regions: the lumbar region, right axillary fossa, right inguinal region, ventral abdominal region, right lateral thorax region, internal surface of the auricle, interdigital region of right forelimb, cheek, bridge of nose, and lateral site of antebrachum. Positive correlations were found between SH and CADESI L for the following regions: the inguinal region (r = 0.73) and the interdigital region (r = 0.82), as well as between total CADESI and SH on digital region (r = 0.52). Also, positive correlations were reported for skin pH and CADESI L in the lumbar region (r = 0.57), the right lateral thorax region (r = 0.40), and the lateral antebrachum (r = 0.35). Positive correlations were found in the interdigital region between erythema intensity and the total CADESI-03 (r = 0.60) as well as the CADESI L (r = 0.7). The results obtained suggest that it may be possible to use skin hydration, pH, and erythema intensity to assess the severity of skin lesion but positive correlation was only found in < 13.3% of possible correlations and usage of these measures in dogs is limited.     

Evaluation of the effect of a 0.0584% hydrocortisone aceponate spray on clinical signs and skin barrier function in dogs with atopic dermatitis

The purpose of this study was to evaluate the effects of a topical spray containing 0.0584% hydrocortisone aceponate (HCA) on canine atopic dermatitis (CAD) and to evaluate the skin barrier function during the treatment of CAD. Twenty-one dogs that fulfilled the diagnostic criteria for CAD were included in this study. The HCA spray was applied once a day to the lesions of all dogs for 7 or 14 days. Clinical assessment was performed before (day 0) and after treatment (day 14), and clinical responses were correlated with changes in skin barrier function. CAD severity significantly decreased after 14 days of HCA treatment based on the lesion scores (p < 0.0001), which were determined using the CAD extent and severity index (CADESI-03) and pruritus scores (p < 0.0001) calculated using a pruritus visual analog scale. Transepidermal water loss, a biomarker of skin barrier function, was significantly reduced compared to baseline (day 0) measurements (p = 0.0011). HCA spray was shown to be effective for significantly improving the condition of dogs suffering from CAD. This treatment also significantly improved cutaneous hydration and skin barrier function in the animals.     

Prednisolone therapy for atopic dermatitis is less effective in dogs with lower pretreatment serum 25-hydroxyvitamin D concentrations

Serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured in 20 dogs with atopic dermatitis prior to treatment with a standard therapeutic dosage of prednisolone (0.93-1.06 mg/kg) every other day for 5 weeks after 7 days of treatment with the same dosage once daily. The severity of their physical signs was scored before and 6 weeks after prednisolone treatment by the canine atopic dermatitis extent and severity index version 3 (CADESI-03) and the Edinburgh Pruritus Scale (EPS). The 20 dogs with atopic dermatitis that were treated with prednisolone did not have significantly lower serum concentrations of 25(OH)D than a group of 36 healthy dogs, and the physical severity of the atopic dermatitis was not correlated to pretreatment serum 25(OH)D concentrations. However, dogs which had a marked improvement of their physical signs, defined by a post-treatment EPS score of 0 and/or an 85% reduction in CADESI-03 score, had significantly higher pretreatment serum 25(OH)D concentrations than dogs with a suboptimal response (P = 0.003 and P = 0.03, respectively). Serum 25(OH)D concentrations were also measured in a previously published cohort of atopic dogs that were treated with ciclosporin. This cohort of dogs was recruited in a similar time frame to the prednisolone-treated dogs, and all samples were handled in the same way. In contrast to the prednisolone-treated dogs, there was no significant difference in 25(OH)D concentrations in dogs that responded optimally to ciclosporin compared with suboptimal responders. Additional studies are required to establish whether vitamin D has a synergistic therapeutic effect with prednisolone in dogs with atopic dermatitis.     

Efficacy of a 0.0584% hydrocortisone aceponate spray in the management of canine atopic dermatitis: a randomised, double blind, placebo-controlled trial

This study evaluated a 0.0584% hydrocortisone aceponate (HCA) spray (Cortavance®; Virbac SA, Carros, France) in canine atopic dermatitis (AD). Initially, dogs with a canine AD extent and severity index (CADESI-03) ≥ 50 were randomly allocated to receive HCA ( n  = 15) or placebo ( n  = 13) (two sprays from 10 cm away to treat an area of 100 cm²) once daily for 28 days. Twenty-one of the dogs then received HCA spray once daily, reducing to every other day or twice weekly over 42 days if improvement was maintained. CADESI, pruritus (14 cm visual-analogue-scale) and owner satisfaction (5-point scale) were recorded every 14 days. Haematology, biochemistry and adrenocorticotrophic hormone stimulation were performed at baseline, d28 and d70 (HCA n  = 9; placebo n  = 7). Intention-to-treat data were analysed. HCA spray significantly decreased CADESI (–61.4% versus –13.4%, P  = 0.0069) and pruritus (–38.8% versus +57.6%, P  = 0.0015) at d28 compared to placebo. Scores were significantly decreased at d14 (CADESI –50.5%, P  < 0.0021) and d28 (CADESI P  < 0.0001; pruritus P  = 0.018) compared to baseline following HCA but not placebo. At d28 11 of 15 and 7 of 15 HCA dogs had ≥ 50% reductions in CADESI and pruritus compared to 3 of 13 ( P  = 0.02) and 1 of 13 ( P  = 0.04) placebo dogs. Owner satisfaction scores were significantly higher in the HCA group (d28 P  = 0.0001). Daily 3 of the 21 dogs required daily maintenance therapy, 7 every other day, 6 twice weekly and 5 dogs required additional therapy. Coat length did not influence the results. No adverse effects or changes to blood parameters were noted. HCA spray proved safe and effective up to 70 days. It is not, however, licensed for long-term treatment.     

Staphylococcal colonization of mucosal and lesional skin sites in atopic and healthy dogs

Staphylococcal colonization was compared in healthy dogs and in dogs with atopic dermatitis. Bacterial swabs were collected from the nasal mucosa, ear and perineum of 43 healthy and 24 atopic dogs and also from potentially infected skin lesions of the atopic dogs. Coagulase positive staphylococcal isolates were identified to the species level. At the time of this study Staphylococcus intermedius was considered a single species but has since been recognized as comprising at least three species with canine isolates believed to belong to Staphylococcus pseudintermedius . Of atopic dogs, 87.5% were colonized with S. intermedius compared to only 37.2% of healthy dogs. The ear was the only carriage site that showed any significant difference in S. intermedius isolation between healthy and atopic dogs. The perineum represented the most frequently colonized mucosal site for both groups. Sampling the nasal mucosa alone identified 71.4% of atopic and 37.5% of healthy S. intermedius carriers. Inclusion of a perineal swab identified 100% of atopic and 93.8% of healthy carriers. S. intermedius was isolated from all the lesional sites sampled from atopic dogs. Significantly fewer dogs were colonized by Staphylococcus aureus than S. intermedius , and there was no significant difference between S. aureus colonization of atopic and healthy dogs. S. aureus was not recovered from any lesions in atopic dogs. The results show that S. intermedius carriage is more prevalent in atopic dogs compared to healthy dogs and that to identify staphylococcal carriers both the nasal mucosa and the perineum should be sampled.     

Masitinib decreases signs of canine atopic dermatitis: a multicentre, randomized, double-blind, placebo-controlled phase 3 trial

This study investigated the efficacy and safety of masitinib, a selective tyrosine kinase inhibitor capable of downregulating mast cell functions, for treatment of canine atopic dermatitis (CAD). Dogs with confirmed CAD received masitinib at 12.5 mg/kg/day (n = 202) or control (n = 104) for 12 weeks. A reduction in CAD Extent and Severity Index (CADESI-02) score of ≥ 50% at week 12 was observed in 61% of masitinib-treated dogs versus 35% of control dogs (P < 0.001), according to the modified intent-to-treat population. For dogs resistant to ciclosporin and/or corticosteroids (60% of the study population), CADESI-02 response rates were 60 versus 31%, respectively (P = 0.004). The mean reduction in pruritus score of severely pruritic dogs was 46 versus 29%, respectively (P = 0.045). Furthermore, 65% of owners with severely pruritic dogs assessed masitinib efficacy as good/excellent versus 35% control (P = 0.05). Overall, 63% of investigators assessed masitinib efficacy as good/excellent versus 35% control (P < 0.001). Premature discontinuations from the modified intent-to-treat population (28.2% masitinib versus 26.0% control) were mainly due to adverse events (13.4 versus 4.8%, respectively) or lack of efficacy (12.4 versus 18.3%, respectively). In total, 13.2% dogs presented with severe adverse events (16.0% masitinib versus 7.7% control). Masitinib showed a risk of reversible protein loss, although regular surveillance of blood albumin and proteinuria allowed for discontinuation of treatment while the dog was still clinically asymptomatic. Masitinib proved to be an effective and mostly well-tolerated treatment of CAD, including severe and refractory cases, with medically manageable adverse effects.