Efficacy of GS-441524 for Feline Infectious Peritonitis: A Systematic Review (2018-2024)

Abstract

Feline infectious peritonitis (FIP) is a severe viral disease with a very high fatality rate. GS-441524 is an adenosine analogue that acts as an antiviral and has shown promise in FIP treatment. However, its commercialization in some regions is not yet authorized. To evaluate the efficacy of GS-441524 based on the published literature, a systematic review was conducted. This systematic review was conducted using PubMed, ScienceDirect, and Google Scholar for studies published from 2018 onwards. Following PRISMA guidelines, 11 studies (totaling 650 FIP cases treated with GS-441524 alone or in combination) were included. Therapeutic efficacy was assessed by FIP form, clinical signs, and dosage. The overall treatment success rate was 84.6%. This rate was higher when GS-441524 was combined with other antivirals and lower in cases of wet FIP or those with neurological complications. Combination therapy with other antivirals may improve outcomes in complicated FIP cases, although further studies are needed. The GS-441524 dosages associated with the best outcomes were 5-10 mg/kg once daily (or equivalent subcutaneous dose), adjusted for FIP type, severity, and presence of neurological/ocular signs. Higher dosages can be used for severe cases or to prevent relapse, but splitting into twice-daily dosing may be necessary to avoid absorption issues. In summary, this synthesis indicates that GS-441524 is a highly promising treatment for FIP, with a high success rate among treated cases. Nevertheless, randomized controlled trials are needed to establish evidence-based therapeutic protocols tailored to different FIP presentations.

Keywords: GS-441524; antiviral treatment; efficacy; feline coronavirus; feline infectious peritonitis; molnupiravir; remdesivir.

Figure 1

Clinical decision-making diagram for cats diagnosed with feline infectious peritonitis (FIP). Cats presenting with FIP typically exhibit either the effusive or non-effusive form of the disease. The effusive form may manifest as ascites, bicavitary effusions, or pleural effusion. Cats with either form may additionally present aggravating clinical signs, including neurological symptoms, ocular involvement, or nephropathy. Treatment options include GS-441524, alone or in combination with supportive therapies, resulting in several possible clinical outcomes: remission, remission after relapse, relapse requiring a treatment change, death after relapse, or death without remission.