Feline Infectious Peritonitis (FIP) Statement November 2020

 

The London Cat Clinic is acutely aware of novel FIP treatment modalities being offered and readily available on the black market. As feline clinicians we understand the dire need for effective treatment of this inevitably fatal disease. We understand the emotion that drives the decision-making process to obtain such drugs from sources that are not commercially or legally available to us.

The University of California, Davis has provided pilot studies involving GS-441524 (nucleoside analogue) and GC376 (protease inhibitor) with very promising results. Since these studies were first published, oral and injectable formulations of the drugs have been offered online, unlicensed by the patent holder Gilead Sciences Inc. and not subject to any external quality control. More information can be found on the University of California, School of Veterinary Medicine website. Even if these products were available to the veterinary market, their use would be considered experimental. However, there is currently no legal source of these compounds which means that all products assumed to contain GS-441524, GS376 or analogues are distributed without any regulatory body being involved.

The London Cat Clinic does not promote the use of such unlicensed products.

We emphasise that any privately obtained compounds of unknown composition, shelf-life, concentration, toxicity and efficacy cannot be recommended by any veterinarian.   Neither can we advise on dosage, frequency, duration of treatment or appropriate monitoring of side effects as this is in stark conflict with the Royal College of Veterinary Surgeons’ Code of Professional Conduct.

The London Cat Clinic does not offer any advice on obtaining unlicensed products nor do we assist in their administration, by tablet, injection or otherwise.  

The welfare of our patients is of the highest priority to us.

If an owner, out of desperation, is starting treatment with unlicenced and privately obtained medications against all advice we will  fulfil our ethical and legal duty to ensure the individual cat’s medical care is not neglected.

In cases where FIP is a possibility, confirmation of the diagnosis of FIP must be sought to ensure cats not suffering from FIP are not put at an unacceptable risk by the inappropriate use of an unlicensed drug, or of having more suitable treatment withheld if the disease isn’t in fact FIP.

As veterinarians we are here to ensure that owners of cats with FIP that have chosen to pursue unlicensed therapy are not compromising the individual cat's welfare. This is especially important, should treatment be unsuccessful, and euthanasia be considered. We also ensure that cats being put at risk by their owner’s treatment decisions are monitored for adverse reactions, which are impossible to predict. 

As veterinarians, it is our duty to use our skills to the benefit of the patients under our care, irrespective of their owner’s decisions.

We are prepared to monitor the clinical evolution of the patient undergoing unlicenced treatment and discuss palliative care options if necessary. Scheduling of repeat exams and further tests or therapeutic approaches will depend on the individual case.  

It has come to our attention that some manufacturers of products assumed to contain GS-442524 are currently advising their customers to have their cats undergo frequent blood tests and ultrasound scans to monitor the treatment outcome. Whilst close monitoring of critically ill patients is of course good medical practice, there are some major concerns about this.

1) These companies are not subject to any ethical or scientific review and have an obvious conflict of interest in publishing their results, even if their compounds were to undergo medical and legal scrutiny.

2) Owners are being recruited into ongoing studies and asked to commit to a monitoring schedule that did not undergo any such review. In the UK, scientific studies on animals require licensure under the Animal (Scientific Procedures) Act 1986 which regulates procedures that may cause pain, distress, suffering or lasting harm to animals. The Veterinary Surgeons Act 1966 which regulates the veterinary profession does not cover elective, scientific procedures. We are hence legally and ethically bound to not carry out procedures without a clear clinical need. 

No monitoring schedules beyond the original publications proving drug efficacy have been published to justify any monitoring. We cannot stress enough that even if there was a published treatment and monitoring protocol available to us, we have no information on the currently available black-market compounds. These may in fact not even be remotely related to the drugs used in the publications by UC Davis. We are hence legally and ethically prohibited from performing elective procedures (that could pose a stressor to the cat’s immune system) without a clinical benefit for the individual cat. 

November 2020