Randomized Open-Label Clinical Trial Comparing Prednisolone and Cyclosporine With a Nonrandomized Active Control for Treating Presumed Chronic Pancreatitis in Cats

Abstract

Background: Current management for chronic pancreatitis in cats is largely symptomatic. Anecdotal reports suggest that immunomodulatory treatment can be helpful in some cases, but limited data is available.

Objectives: Compare the effects of symptomatic treatments alone, an immunosuppressive dosage of prednisolone, or modified cyclosporine on serum feline pancreatic lipase immunoreactivity (fPLI) concentration and clinical activity index (CAI).

Animals: Forty-eight client-owned cats with a presumptive diagnosis of chronic pancreatitis were managed on an outpatient basis.

Methods: Three-week randomized open-label trial with a nonrandomized active control. Owners elected to join either the control or the treatment group; cats enrolled in the treatment group were randomized to receive either prednisolone or cyclosporine. Serum fPLI concentration and clinical signs were recorded at baseline and on Days 10 and 21.

Results: The average decrease in serum fPLI concentration was 13.0 μg/L (95% CI, -23.9 to -0.9 μg/L) larger for the cyclosporine group (n = 17) than for the control group (n = 16) and 27.6 μg/L (95% CI, -41.2 to -11.4 μg/L) larger than for the prednisolone group (n = 15). The average decrease in CAI was 1.9 points (95% CI, -2.7 to -1.2) larger for the prednisolone group than for the control group and 1.2 points (95% CI, -2.1 to -0.4) larger than for the cyclosporine group.

Conclusions: Over a 3-week treatment period, cats with presumed chronic pancreatitis that received cyclosporine had a larger decrease in serum fPLI concentration compared with cats that were treated with an immunosuppressive dosage of prednisolone or cats that received only symptomatic treatments. However, clinical improvement was more apparent with prednisolone, but not cyclosporine.

Keywords: CsA; Spec fPL; corticosteroid; feline; hyperlipasemia; pancreas; pancreatic lipase.

FIGURE 1

Study timeline and main outcomes. fPLI, feline pancreatic lipase immunoreactivity. Created in BioRender. Wu. 2025. https://BioRender.com/t85g250.

FIGURE 2

Flow diagram of the progress through the phases of the study. fPLI, feline pancreatic lipase immunoreactivity.

FIGURE 3

Serum fPLI concentration over time in cats with presumed chronic pancreatitis treated with symptomatic treatments alone (control), immunosuppressive dosage of prednisolone and symptomatic treatments (prednisolone), or cyclosporine and symptomatic treatments (cyclosporine). First screening: The time point when the first serum fPLI concentration was screened; Baseline: The time point when the second (baseline) serum fPLI concentration was screened; Day 10: Day 10 of the study; Day 21: Day 21 of the study; fPLI, feline pancreatic lipase immunoreactivity. Red bars represent the medians. The gray area denotes the reference interval. Dotted lines at serum fPLI concentration = 5.4 and 8.8 represent previous and current cutoffs considered consistent with a diagnosis of pancreatitis, respectively. Differences between time points were tested with the Friedman test followed by the Conover post hoc test for each group; p values < 0.05 were shown. The corresponding descriptive statistics can be found in Table S10.

FIGURE 4

Changes in serum fPLI concentration between time points in cats with presumed chronic pancreatitis treated with symptomatic treatments alone (control), immunosuppressive dosage of prednisolone and symptomatic treatments (prednisolone), or cyclosporine and symptomatic treatments (cyclosporine). Baseline vs. first screening: Indicating changes in serum fPLI concentration between baseline and first screening; Day 10 vs. baseline: Indicating changes in serum fPLI concentration between Day 10 and baseline; Day 21 vs. baseline: Indicating changes in serum fPLI concentration between Day 21 and baseline; fPLI, feline pancreatic lipase immunoreactivity. Red bars represent the medians. Dotted line represents 0 changes, indicating no change in serum fPLI concentration. Differences were tested with the Friedman test followed by the Conover post hoc test for each group; p values < 0.05 were shown. The corresponding descriptive statistics can be found in Table S11.

FIGURE 5

Clinical activity index and each clinical variable over time in cats with presumed chronic pancreatitis treated with symptomatic treatments alone (control, n = 15, in orange triangles), immunosuppressive dosage of prednisolone and symptomatic treatments (prednisolone, n = 15, in black circles), or cyclosporine and symptomatic treatments (cyclosporine, n = 17, in blue squares). No cat was clinically icteric at any time point during the study. Red bars represent the medians of the variable. Baseline: The time point when the second (baseline) serum fPLI concentration was screened; Day 10: Day 10 of the study; Day 21: Day 21 of the study. Differences in clinical activity index were tested with the Friedman test followed by the Conover post hoc test for each group; p values < 0.05 were shown.