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Get the latest news on canine inappetence and ENTYCE® (capromorelin oral solution), the only FDA-approved veterinary therapeutic for stimulating appetite in dogs.
The Clinical Impact of Inappetence and Importance of Early Intervention
We’ve all had those cases; the 13 year-old Shih Tzu with chronic kidney disease, the 10 year-old Cocker Spaniel struggling with heart failure, and even that one year old German shepherd who recently had GDV surgery. One of the most common problems they may all face is inappetence.
While these patients need proper nutrition to help improve their physical condition, inappetence also places an emotional toll on families and the human animal bond. Pet owners are faced with increasingly more difficult treatment decisions when their pet stops eating.
There are three forms that we need to recognize to help our patients maintain their optimal nutritional intake. It is important to look for signs and intervene early.
Hyporexia is a decrease in eating. While this may be a subtle change to many pet owners, it can be an early, key indicator of underlying disease.
Hyporexia can lead to anorexia, which is a complete loss of appetite. While anorexia is easily recognized by most clients, dysrexia may be harder to identify.
Dysrexia, the third form of inappetence, describes an altered pattern of eating and may not seem abnormal to clients. It’s not only important to be asking what and how much a dog is eating at a physical exam, but also the pattern and consistency.
Once inappetence has been identified in the canine patient, treatment with ENTYCE can be started while we still search for the underlying cause. ENTYCE works by mimicking ghrelin “the hunger hormone.” It binds receptors in the brain and signals the hypothalamus to trigger the feelings of hunger. It is extremely important to help restore nutrition while we wait for our test results to come back.
A common assumption, though, is that nausea is the primary cause of inappetence. While that can be the situation in some cases, nausea can be difficult to detect and treat in our veterinary patients. Vomiting, if present, can be managed with anti- emetics, however the use of ENTYCE will likely still be required to stimulate appetite. It is important to remember that inappetence is usually a symptom of an underlying disease; so, improving a dog’s appetite should be a priority.
ENTYCE has worked incredibly well in my practice, but case selection and early intervention is critical to success. So what type of cases present with inappetence? Chronic cases like advancing kidney disease, heart disease, severe gastrointestinal disease and cancer are ones we commonly see in practice, but our acute cases can certainly carry risks of inappetence as well. These include post-surgical recovery, gastrointestinal disease and even behavioral cases, like food aversions.
By looking for signs of inappetence, we can identify potential issues at an earlier stage in the disease process. Early intervention and treating with ENTYCE may help to get our canine patients to an improved nutritional state for potentially better clinical outcomes. And, as pet owners see appetite as being so important in terms of their animals’ quality of life, you might just make your clients happier. And of course, seeing those improved outcomes in our patients and clients will help improve our professional satisfaction too.
Recognizing and Treating Inappetence in Dogs
Hello, I’m Dr. Jessica Larson, Veterinary Medical Liaison for Aratana Therapeutics. Throughout my years as a practicing veterinarian, I’ve wanted to be able to do more for my canine patients suffering from inappetence.
As we all know, decreased eating is not only a concern for our clients. It is also concerning for us veterinarians, as many times it is the first and only sign that the dog is sick.
Let’s face it: inappetence, in its different manifestations, is a common complaint. It is most frequently associated with anorexia, or a complete lack of eating. But it is much bigger than that. We must also consider the hyporexic patient with decreased food intake, and the dysrexic patient with altered patterns of eating, which may be more commonly seen in practice than anorexia.
All of these types of inappetence can have a tremendous negative impact and result in the patient not getting the nutritional intake they need. That is a big deal, as you know, and it is why it’s so important to look for and monitor any changes in eating behavior.
Inappetence is more prevalent than you may think, with an average of 14% of canine patients suffering from it. And most veterinarians have stated that in a typical month, up to one quarter of the dogs they see in clinic are inappetent.
We veterinarians have continued to struggle with treating inappetence due to having only limited options – and all of them being extra-label. In fact, results from market research Aratana conducted with 155 veterinarians in early 2014 found that 81% stated they felt there’s a need for a product indicated specifically to stimulate appetite.
And, to that point, only 40% of those same veterinarians reported that they even treat inappetence, feeling “nothing works well.”
There are a multitude of causes for inappetence. We know that inappetence can be a symptom of many underlying diseases and conditions, both chronic and acute. Some of the many conditions you likely see regularly are kidney disease, gastrointestinal disease, heart disease, post-surgical pain, or even psychological conditions from environmental changes, such as boarding, and changes in diet.
We know improper food intake can have a tremendous negative impact on a dog’s underlying disease. It may also affect the veterinarian’s ability to diagnose the underlying condition and continue treatment.
Clinically, long-term lack of nutrition and food intake may also delay wound healing and decrease immune response.
Another factor we can’t over-emphasize is the emotional distress pet owners may feel. They often perceive an inappetent dog as suffering and associate poor eating with decreased quality of life. Many times, this can lead to their decision to euthanize their beloved pet.
The good news is that finally, appetite stimulation is in your control. ENTYCE® (capromorelin oral solution), is a first-in-class treatment – and the only FDA-approved veterinary therapeutic to safely and effectively stimulate appetite in dogs.
ENTYCE works by mimicking ghrelin, the hunger hormone. Like naturally- occurring ghrelin, ENTYCE binds to specific receptors and affects signaling in the hypothalamus. This stimulates the feeling of hunger, which leads the dog to eat.
A laboratory effectiveness study demonstrated a 61% increase in food consumption in healthy dogs receiving ENTYCE versus placebo over four days of treatment.
And in the clinical field study, 69% of the clinically-inappetent, client-owned dogs receiving ENTYCE had an increase in appetite.
Not only did ENTYCE demonstrate it was effective for increasing appetite, the results of the laboratory safety study showed it to be well tolerated and safe for long-term use.
ENTYCE was tested for 12 months, with dose ranges at up to 17.5 times the recommended therapeutic dose of 3 mg/kg in healthy dogs … with the most common adverse events being emesis, loose stools and excess salivation.
Separately, in the clinical field study, the most commonly reported AE findings were diarrhea and vomiting in similar numbers in both placebo and ENTYCE treated groups.
All of these published efficacy and safety studies are available at entyce.aratana.com.
ENTYCE is a synthetic vanilla flavored oral solution that’s given once daily. It is convenient to administer and is dosed at a relatively small volume. For example, a dog that is 13.6 kg — or 30 lbs — would require 1.4 mLs per dose.
To summarize, we have discussed how improper food intake can have a tremendous negative impact on a dog’s underlying disease — and may affect the veterinarian’s ability to diagnose the underlying condition and continue treatment.
In addition to this potential clinical impact, there is the emotional distress pet owners may feel by perceiving the dog as suffering and associating poor eating with decreased quality of life.
We reviewed the multitude of causes for inappetence as a symptom of many underlying diseases and conditions, both chronic and acute.
I can’t stress enough the importance of recognizing and monitoring any changes in eating behavior.
Until now, there have been limited treatment options. ENTYCE is the only FDA-approved veterinary therapeutic that is safe and effective to treat your canine patients’ inappetence, so you can focus on the underlying cause of their chronic or acute condition.
To learn more, visit entyce.aratana.com or call Aratana Customer Service at 1-800-ARATANA. You can also contact your authorized ARATANA distributor.
Appetite and Quality of Life: An Owner’s Perspective
Whenever we encounter a patient with declining health, it can be incredibly stressful—not only for that patient but also for the pet parent and of course for you, the veterinarian.
A cancer diagnosis is challenging for any client to hear and process, but our patients battling cancer deserve to have the best quality of life that they can, to feel the best that they can on a daily basis.
Our patient, Winnie May, has cancer and instead of going through every process possible knowing what the outcome will still be, her mother Jenna has decided to give her as much love as she can with the life she has left.
“So she’s 12, and with chemotherapy or radiation I just, um, you know, I don’t want to put her through all that. And to me, as long as she’s eating, if she’s slowing down a little bit that’s fine. If she’s got some joint pain, we can give her things for that. That’s fine, but the true joy that a pug has is eating, and so as long as she’s eating, I’m happy to have her here with us.
We have a bucket list for her and she’s enjoying all sorts of things. She’s enjoying doggy cones at Scooter’s. She gets free munchkins at the Dunkin’ Donuts up the street because they know she’s sick.”
Winnie May had a malignant intestinal tumor. We surgically resected it, but we know, based on its behavior, there’s a high probability it will come back.
To help Winnie May with her surgical recovery, I prescribed the appetite stimulant, ENTYCE®. Appropriate nutrition is essential to wound healing and I wanted to get Winnie May back to normal as soon as possible so her mom could enjoy every moment with her.
“I’ve had the time to really focus on Winnie and, you know, knock off some of these things. I take her on every car ride I can possibly take her. We go on walks. As long as she’s not in pain and they can give her a medicine to make her feel like her joints won’t hurt and anything. You know, I keep saying the same thing, but the greatest joy a pug has is to eat.”
It’s devastating when we lose a loved one. Some even say it’s the price of love. However, it’s even harder when our pet parents are not able to see their family members living with dignity and quality in their twilight time in life.
One of the ways we so often measure that quality is by seeing our dogs eating. ENTYCE stimulates the dog’s appetite. And in cases like Winnie May’s, it could give them and their owners that much needed time, which is priceless.
“I mean, this is my first born in a sense, and she, it’s just been us girls, especially when I got divorced. It was the three of us. We were just hanging out, and we would always say ‘girl power.’ And Winnie was just, she’s just always been there. She’s been there through everything.”
We know that for many pet parents, watching their family member eat in the midst of battling a chronic disease is a sign of comfort and peace of mind. With the help of ENTYCE, Winne May and her family have just that, enjoying their days together now much more. And I can have peace of mind watching families like Jen and Winnie May benefit from this extra time and strengthen their human-animal bond. ENTYCE has been a blessing for them and so many of our clients and is helping to allow even our cancer patients to live with dignity.
IMPORTANT SAFETY INFORMATION: ENTYCE® (capromorelin oral solution) is for use in dogs only. Do not use in breeding, pregnant or lactating dogs. Use with caution in dogs with hepatic dysfunction or renal insufficiency. Adverse reactions in dogs may include diarrhea, vomiting, polydipsia, and hypersalivation. Should not be used in dogs that have a hypersensitivity to capromorelin. Please see the full Prescribing Information for more detail.