Alternatives for trilostane and mitotane? retinoic acid and cabergoline

[Leon]

I finally found out that our dog does not have Cushing, but while cleaning up my bookmarks, like erasing a bad dream, I found 2 bookmarks I want to share with you.

They mentinion retinoic acid and cabergoline as effective in a certain percentage of dogs.

I hope this information can be useful to some of you.


http://www.sciencedirect.com/science...a121b9d97389e6


http://www.hospitalveterinariopompei...oic%20acid.pdf

[lulusmom]

Leon,

Thank you so much for sharing this information with us. I am aware of both of these studies and I was extremely excited about the success in treating with retinoic acid. Retinoic acid actually reduced tumors of all sizes and some tumors totally disappeared which was amazing. The study was a huge success and ongoing monitoring of dogs in that study are still showing great results. Unfortunately, I discovered from two very good sources that there are a few problems that I doubt that we can overcome here in the states; 1) getting retinoic acid imported has not been successful and 2) the cost is absolutely outrageous. At 2mg/kg to treat, the cost to treat a dog weighing 20lbs is about $2400 a day. Yikes!!

It's been a while since I read anything on the caborgaline study but it's efficacy is much lower than either Trilostane or Mitotane. I also believe the reason the dogs treated with caborgaline lived longer than the control group is that dogs in the control group were treated with ketoconazole. Ketoconazole is rarely used in the U.S. because of low efficacy rate and side effects, the worst of which is liver damage. I honestly believe that the survival rate of a control group treated with Mitotane or Trilostane would have probably been higher than those dogs treated with caborgaline. Both the retinoic acid and caborgaline studies were done in South America and for some reason, ketoconazole is the number one treatment of choice there.

Glynda

[drmvz]

Hello, I am in the diagnostic stage with my dog (Banzai) He has some of the classic symptoms and his ldds was inconclusive/positive.
Cornells reference range for the 8 hr is 0-0.5 ug/dl and banzais 8 hr was 1.14 ug/dl. a lot of labs use >1.4 ug/dl on the 8 hr as positive. So i will probably do acth stim as well as ultrasound in the coming weeks. More about banzai on another thread...
I have looked into all treatments as well and was very excited about the retinoic acid study...there is a oral medication called Toctino (which is 9 - cis retinoic acid - used in the study)
The cost at 2mg/kg/day for a 30 lb dog would be $25. Here are some links for anyone interested...

http://en.wikipedia.org/wiki/Alitretinoin
http://www.toctino.co.uk
http://www.pharmacychecker.com/compa...g/84283/162429

[drmvz]

prices...
http://www.pharmacychecker.com/compa.../84283/162429/

link to study...

http://www.2ndchance.info/cushingscastillo2006.pdf

[lulusmom]

I don't have time to read the study again but I believe a different type of retinoid was used so I'm not sure Alitretinoin is appropriate for canine cushing's. I'll have to do some reading.

[drmvz]

The "common" form is 13-cis which is accutane...study was done with 9-cis.
I am currently researching all studies in which dogs have been dosed with any of the 3 types of retinoic acid.
Thanks for all the work you guys have done here.
Dr. Mike

[Squirt's Mom]

Dr. Mike,

Thank you for researching this disease on behalf of all our babies. I wish there was more devotion to finding better care and hope for a cure for canine Cushing's.

Hugs,
Leslie

[busyman370]

Hello, I am in the diagnostic stage with my dog (Banzai) He has some of the classic symptoms and his ldds was inconclusive/positive.
Cornells reference range for the 8 hr is 0-0.5 ug/dl and banzais 8 hr was 1.14 ug/dl. a lot of labs use >1.4 ug/dl on the 8 hr as positive. So i will probably do acth stim as well as ultrasound in the coming weeks. More about banzai on another thread...
I have looked into all treatments as well and was very excited about the retinoic acid study...there is a oral medication called Toctino (which is 9 - cis retinoic acid - used in the study)
The cost at 2mg/kg/day for a 30 lb dog would be $25. Here are some links for anyone interested...

http://en.wikipedia.org/wiki/Alitretinoin
http://www.toctino.co.uk
http://www.pharmacychecker.com/compa...g/84283/162429

I too have read good things about Retinoic Acid. I think it deserves further investigation regarding the dose needed, the cost, the price and what's involved in getting it.

I am going to discuss this with my Vet soon.

Fred

[hoover_nyc_chihuahua]

Fast forward a few years to Dec 2016,

Has anyone heard of anything recent about retinoic acid and or carbegoline treatments?

My 14 year old Chihuahua Hoover has been on Vetroyl for a few months and is tolerating it well. He is 6.5 pounds of pure grit and quite a character. I have no complaints and I'm grateful, however. . .

I wish there was a safe drug to shrink a pituitary tumor. Even though I'm not going to put my dog under for MRIs to quantify the size, if the drug were low risk, why not try to fix this rather than just ameliorate symptoms with Vetroyl?

Any thoughts?

[labblab]

For the benefit of other readers who may also come across this older thread, here's the link to a more recent/current discussion of these medications:

http://www.k9cushings.com/forum/showthread.php?t=8338

Marianne