You are here

Головна » Scientific Journal of Veterinary Medicine 2'2024

World experience in the treatment of feline infectious peritonitis

Treatment of the feline infectious peritonitis (FIP), which is caused by the mutated feline coronavirus (FIPV), has been remaining a challenge for the experts in veterinary medicine and a real lottery of life for the patients with this diagnosis for an exceedingly long time. Experts in a variety of countries were trying to identify an effective way of FIP treatment by experimenting with the search and selection of the right dosage of the main drugs, as well as with the duration of therapeutic treatment. This article analyzes publications in open access courses in the English and Ukrainian languages, in which the topic was related to the experience of treatment of FIP and were published from January 2019 to August 2024. The analysis covers twenty scientific publications where the authors revealed the details of FIP treatment, including the main drugs, their dosage for various types of feline infectious peritonitis, duration of treatment and duration of life of the patients in the state of remission. Two publications contained protocols of FIP treatment that were offered by the authors of those publications at the background of successful treatment of this disease. In the result of the work through the scientific sources we found that the golden standard of feline infectious peritonitis treatment at the current stage is the use of the antiviral drug GS-441524 and its nucleoside analogue Remdesivir. The dosage of these drugs is estimated in the range of 10 to 20 mg/kg depending on the form of FIP and the severity of the patient’s condition with the effective duration of treatment from 28, 42 and up to 84 days with oral or subcutaneous introduction of the drug once in 24 hours. At the same time, we found a not less effective alternative antiviral drug called Molnupiravir with the same dosage conditions and with oral introduction once in 12 hours during 84 days. Molnupiravir is cheaper and available in Ukraine and is used as a substitute-drug in case of resistance to GS-441524. The research indicated a 10% to 30% relapse of FIP where the treatment success is seen to be dependent on the conditions of treatment. The authors of the article suggest that the future research in this field should focus on the identification of possible epigenetic aptitude for or resistance to FIP and the decrease of the antiviral therapy period during the treatment of FIP.

Key words: treatment of feline infectious peritonitis, treatment protocol, GS-441524, Remdesivir, Molnupiravir.

MURASHKO T. https://orcid.org/0000-0003-4168-9943


  1. Felten, S., Hartmann, K. (2019). Diagnosis of Feline Infectious Peritonitis: A Review of the Current Literature. Viruses. no. 11, pp. 1068–1103. DOI:10.3390/v11111068
  2. Hughes, D., Brady, R.A. (2021). Feline infectious peritonitis treatment protocol. Control and Therapy Series. pp. 7–12. Available at:http://www.ve.edu.au/Common/Uploaded% 20files/CT/FIPall-3.pdf (Accessed: 15.08.2024).
  3. Hughes, D. (2022). Update on cat no. 5896: a feline infectious peritonitis (fip) treatment protocol. Control and Therapy Series. pp. 3–6. Available at:http://www.cve.edu.au/Common/ Uploaded%20files/CT/FIP-all-3.pdf (Accessed: 10.08. 20 24).
  4. Delaplace, M., Huet, H., Gambino, A., Le Poder, S. (2021). Feline coronavirus antivirals: A review. Pathogens. Vol. 10, no. 9, pp. 1150–1166. DOI:10.3390/pathogens10091150
  5. Mulligan, A.J., Browning, M.E. (2024). Quality assessment and characterization of unregulated antiviral drugs for feline infectious peritonitis: implications for treatment, safety, and efficacy. American Journal of Veterinary Research, Vol. 85, no. 3, pp. 1–9. DOI:10.2460/ajvr.23.10.0221
  6. Kent, A.M., Guan, S., Jacque, N., Novicoff, W., Evans, S.J. (2024). Unlicensed antiviral products used for the at-home treatment of feline infectious peritonitis contain GS-441524 at significantly different amounts than advertised. Journal of the American Veterinary Medical Association, Vol. 262, no. 4, pp. 1–9. DOI:10.2460/javma.23.08.0466
  7. Meli, M.L., Spiri, A.M., Zwicklbauer, K., Krentz, D., Felten, S., Bergmann, M., HofmannLehmann, R. (2022). Fecal feline coronavirus RNA shedding and spike gene mutations in cats with feline infectious peritonitis treated with GS-441524. Viruses. Vol. 14, no. 5, pp. 1069–1089. DOI:10.3390/v14051069
  8. Krentz, D., Zenger, K., Alberer, M., Felten, S., Bergmann, M., Dorsch, R., Hartmann, K. (2021). Curing cats with feline infectious peritonitis with an oral multi-component drug containing GS-441524. Viruses. Vol. 13, no. 11, pp. 2228–2257. DOI:10.3390/v13112228
  9. Coggins, S.J., Norris, J.M., Malik, R., Govendir, M., Hall, E.J., Kimble, B., Thompson, M.F. (2023). Outcomes of treatment of cats with feline infectious peritonitis using parenterally administered remdesivir, with or without transition to orally administered GS-441524. Journal of Veterinary Internal Medicine, Vol. 37, no. 5, pp. 1772–1783. DOI:10.1111/jvim.16803
  10. Jones, S., Novicoff, W., Nadeau, J., Evans, S. (2021). Unlicensed GS-441524-like antiviral therapy can be effective for at-home treatment of feline infectious peritonitis. Animals. Vol. 11, no. 8, pp. 2257–2271. DOI:10.3390/ani11082257
  11. Addie, D.D., Bellini, F., Covell-Ritchie, J., Crowe, B., Curran, S., Fosbery, M., Jarrett, O. (2023). Stopping feline coronavirus shedding prevented feline infectious peritonitis. Viruses. Vol. 15, no. 4, pp. 818–832. DOI:10.3390/v15040818
  12. Roy, M., Jacque, N., Novicoff, W., Li, E., Negash, R., Evans, S.J. (2022). Unlicensed molnupiravir is an effective rescue treatment following failure of unlicensed GS-441524-like therapy for cats with suspected feline infectious peritonitis. Pathogens. Vol. 11, no. 10, pp. 1209– 1224. DOI:10.3390/pathogens11101209
  13. Sase, O. (2023). Molnupiravir treatment of 18 cats with feline infectious peritonitis: a case series. Journal of Veterinary Internal Medicine, Vol. 37, no. 5, pp. 1876–1880. DOI:10.1111/jvim.16832
  14. Cosaro, E., Pires, J., Castillo, D., Murphy, B.G., Reagan, K.L. (2023). Efficacy of oral remdesivir compared to GS-441524 for treatment of cats with naturally occurring effusive feline infectious peritonitis: a blinded, non-inferiority study. Viruses. Vol. 15, no. 8, pp. 1680–1695. DOI:10.3390/v15081680
  15. Barua, S., Kaltenboeck, B., Juan, Y.C., Bird, R.C., Wang, C. (2023). Comparative evaluation of GS-441524, teriflunomide, ruxolitinib, molnupiravir, ritonavir, and nirmatrelvir for in vitro antiviral activity against feline infectious peritonitis virus. Veterinary Sciences. Vol. 10, no. 8, pp. 513–527. DOI:10.3390/vetsci10080513
  16. Cerna, P., Ayoob, A., Baylor, C., Champagne, E., Hazanow, S., Heidel, R.E., Gunn-Moore, D.A. (2022). Retrospective survival analysis of cats with feline infectious peritonitis treated with polyprenyl immunostimulant that survived over 365 days. Pathogens. Vol. 11, no. 8, pp. 881–895. DOI:10.3390/pathogens11080881
  17. Yu, J., Kimble, B., Norris, J.M., Govendir, M. (2020). Pharmacokinetic profile of oral administration of mefloquine to clinically normal cats: a preliminary in-vivo study of a potential treatment for feline infectious peritonitis (FIP). Animals. no. 10, pp. 1000–1014. DOI:10.3389/fvets.2022.1002488
  18. Doki, T., Toda, M., Hasegawa, N., Hohdatsu, T., Takano, T. (2020). Therapeutic effect of an anti-human-TNF-alpha antibody and itraconazole on feline infectious peritonitis. Archives of Virology. no. 165, pp. 1197–1206. DOI:10.1007/s00705-020-04605-7
  19. Sharun, K., Tiwari, R., Dhama, K. (2021). Protease inhibitor GC376 for COVID-19: Lessons learned from feline infectious peritonitis. Annals of medicine and surgery. no. 61, pp. 122–125. DOI:10.1016/j.amsu.2020.12.030
  20. Yin, Y., Li, T., Wang, C., Liu, X., Ouyang, H., Ji, W., Hu, C. (2021). A retrospective study of clinical and laboratory features and treatment on cats highly suspected of feline infectious peritonitis in Wuhan, China. Scientific Reports. Vol. 11, no. 1, pp. 5208– 5217. DOI:10.1038/s41598-021-84754-0
  21. Kameshima, S., Kimura, Y., Doki, T., Takano, T., Park, C.H., Itoh, N. (2020). Clinical efficacy of combination therapy of itraconazole and prednisolone for treating effusive feline infectious peritonitis. Journal of Veterinary Medical Science, Vol. 82, no. 10, pp. 1492–1496. DOI:10.1292/jvms.20-0049
  22. Taylor, S.S., Coggins, S., Barker, E. N., Gunn-Moore, D., Jeevaratnam, K., Norris, J.M., Tasker, S. (2023). Retrospective study and outcome of 307 cats with feline infectious peritonitis treated with legally sourced veterinary compounded preparations of remdesivir and GS-441524 (2020–2022). Journal of feline medicine and surgery, Vol. 25, no. 9, pp. 1–26. DOI:10.1177/1098612X231194460
  23. Green, J., Syme, H., Tayler, S. (2023). Thirty-two cats with effusive or non-effusive feline infectious peritonitis treated with a combination of remdesivir and GS-441524. Journal of Veterinary Internal Medicine, Vol. 37, no. 5, pp. 1784–1793. DOI:10.1111/jvim.16804
  24. Cook, S., Wittenburg, L., Yan, V.C., Theil, J.H., Castillo, D., Reagan, K. L., Murphy, B.G. (2022). An optimized bioassay for screening combined anticoronaviral compounds for efficacy against feline infectious peritonitis virus with pharmacokinetic analyses of GS-441524, remdesivir, and molnupiravir in cats. Viruses. Vol. 14, no. 11, pp. 2429–2447. DOI:10.3390/v14112429
  25. Tasker, S., Addie, D.D., Egberink, H., Hofmann-Lehmann, R., Hosie, M.J., Truyen, U., Hartmann, K. (2023). Feline Infectious Peritonitis: European Advisory Board on Cat Diseases Guidelines. Viruses. Vol. 15, no. 9, 18471950 p. DOI:10.3390/v15091847
  26. Izes, A.M., Yu, J., Norris, J.M., Govendir, M. (2020). Current status on treatment options for feline infectious peritonitis and SARS-CoV-2 positive cats. Veterinary Quarterly. Vol. 40, no. 1, pp. 322–330. DOI:10.1080/01652176.2020.1845917
  27. Yu, J., Govendir, M., Norris, J. (2021). Feline infectious peritonitis (FIP) – now a treatable disease. Control and Therapy Series. no. 303, pp. 3–8. Available at:https://cve.edu.au/ Common/Uploaded%20files/CT/FIP-all-3.pdf (Accessed: 05.08. 2024).
  28. Kennedy, M.A. (2020). Feline infectious peritonitis: update on pathogenesis, diagnostics, and treatment. Veterinary Clinics: Small Animal Practice. Vol. 50, no. 5, pp. 1001–1011. DOI:10.1016/j.cvsm.2020.05.002
  29. Allinder, M., Tynan, B., Martin, C., Furbish, A., Austin, G., Bartges, J., Lourenço, B.N. (2024). Uroliths composed of antiviral compound GS-441524 in 2 cats undergoing treatment for feline infectious peritonitis. Journal of Veterinary Internal Medicine, Vol. 38, no. 1, pp. 370–374. DOI:10.1111/jvim.16954
  30. Sorrell, S., Pugalendhi, S.J., Gunn-Moore, D. (2022). Current treatment options for feline infectious peritonitis in the UK. Companion Animal. Vol. 27, no. 6, pp. 79–90. DOI:10.12968/ coan.2022.0016
  31. Pedersen, N.C. (2021). The Long History of Beta-d-n4-Hydroxycytidine and Its Modern Application to Treatment of COVID-19 in People and FIP in Cats. Available at: http://www. ccah.vetmed.ucdavis.edu/sites/g/files/dgvnsk4586/files/inline-files/The%20long%20history%20of%20beta-d-N4-hydroxycytidine%20and%20its%20modern%20application%20to% 20treatment%20of%20Covid-19%20in%20people%20and%20FIP%20in%20cats_0.pdf (Accessed: 08.08.2024).
  32. Perera, K.D., Rathnayake, A.D., Liu, H., Pedersen, N.C., Groutas, W. C., Chang, K.O., Kim, Y. (2019). Characterization of amino acid substitutions in feline coronavirus 3C-like protease from a cat with feline infectious peritonitis treated with a protease inhibitor. Veterinary microbiology. no. 237, 108398 p. DOI:10.1016/j.vetmic.2019.108398
  33. Dickinson, P.J., Bannasch, M., Thomasy, S.M., Murthy, V.D., Vernau, K.M., Liepnieks, M., Pedersen, N.C. (2020). Antiviral treatment using the adenosine nucleoside analogue GS-441524 in cats with clinically diagnosed neurological feline infectious peritonitis. Journal of veterinary internal medicine, Vol. 34, no. 4, pp. 1587–1593. DOI:10.1111/jvim.15780
  34. Pedersen, N.C., Perron, M., Bannasch, M., Montgomery, E., Murakami, E., Liepnieks, M., Liu, H. (2019). Efficacy and safety of the nucleoside analog GS-441524 for treatment of cats with naturall occurring feline infectious peritonitis. Journal of feline medicine and surgery, Vol. 21, no. 4, pp. 271–281. DOI:10.1177/1098612X19825701
  35. Lv, J., Bai, Y., Wang, Y., Yang, L., Jin, Y., Dong, J. (2022). Effect of GS-441524 in combination with the 3C-like protease inhibitor GC376 on the treatment of naturally transmitted feline infectious peritonitis. Frontiers in Veterinary Study. Vol. 9, pp. 1–10. DOI:10.3389/fvets.2022.1002488
  36. Zwicklbauer, K., Krentz, D., Bergmann, M., Felten, S., Dorsch, R., Fischer, A., Hartmann, K. (2023). Long-term follow-up of cats in complete remission after treatment of feline infectious peritonitis with oral GS-441524. Journal of Feline Medicine and Surgery, Vol. 25, no. 8. DOI:10.1177/1098612X231183250
  37. Katayama, M., Uemura, Y. (2023). Prognostic prediction for therapeutic effects of Mutian on 324 client-owned cats with feline infectious peritonitis based on clinical laboratory indicators and physical signs. Veterinary Sciences. Vol. 10, no. 2, pp. 136–150. DOI:10.3390/vetsci10020136
  38. Murphy, B.G., Castillo, D., Neely, N.E., Kol, A., Brostoff, T., Grant, C. K., Reagan, K.L. (2024). Serologic, Virologic and Pathologic Features of Cats with Naturally Occurring Feline Infectious Peritonitis Enrolled in Antiviral Clinical Trials. Viruses. Vol. 16, no. 3, pp. 462–484. DOI:10.3390/v16030462
  39. Zuzzi-Krebitz, A.M., Buchta, K., Bergmann, M., Krentz, D., Zwicklbauer, K., Dorsch, R., Hartmann, K. (2024). Short Treatment of 42 Days with Oral GS-441524 Results in Equal Efficacy as the Recommended 84-Day Treatment in Cats Suffering from Feline Infectious Peritonitis with Effusion – A Prospective Randomized Controlled Study. Viruses. Vol. 16, no. 7, pp. 1144–1167. DOI:10.3390/v16071144
  40. Bochkaryova, A. (2023). Еreatment of viral infectious peritonitis in cats. All-Ukrainian scientific and practical conference of master's students and young researchers "Current problems of veterinary medicine". (Bila Tserkva, 16 Nov. 2023). Bila Tserkva, pp. 18–20. Available at:https://rep.btsau.edu.ua/bitstream/BNAU/11714/1/likuvannja_virusnogo.pdf (Accessed: 30.08. 2024) (in Ukrainian).
  41. Melnyk, S. (2023). Diagnosis and treatment of infectious peritonitis of cats in different forms of the course of the disease. All-Ukrainian scientific and practical conference of master's students and young researchers "Current problems of veterinary medicine". (Bila Tserkva, 16 Nov. 2023). Bila Tserkva, pp. 119–121. Available at:https://rep.btsau.edu.ua/bitstream/ BNAU/11714/1/likuvannja_virusnogo.pdf (Accessed: 30.08.2024) (in Ukrainian).
AttachmentSize
PDF icon murashko_2_2024.pdf625.46 KB
Scientific Journal of Veterinary Medicine 2'2024