Autoimmune Skin Diseases

[Annamalita]

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My dog has recently been diagnosed with an autoimmune skin disease (possibly pemphigus vulgaris this is TBD from a biopsy) and we have to switch her from Prednisone to an immunosuppressant. I have a couple questions about immunosuppressants:

1) how much will they cost? (I know there is probably a range from brand to generic, but any info avail on any type would be nice. I will most likely be getting generic though.)

2) how have dogs typically done on them? Are there long term side-effects?

Thank you!

 

[WhtsThFrequency]

Did your vet not discuss these questions with you?

(not trying to be snarky, actually serious)

 

[Annamalita]

Thanks for your response, I forgot to ask her about the cost of the meds specifically, we have yet to do the biopsy. I just started freaking out that it's going to be so much money to maintain her treatment that fear I don't know what I'm getting myself into... so I thought I would ask here instead of waiting another week to find out from the Dr.

And as for how they fare on the meds, I have been told by my veterinarian that usually dogs don't do so well on immunosuppressants but I was then told by the dermatologist that dogs she has treated have done well on them. So I was given mixed answers and just thought I would hear stories from a larger pool of people.

I did some google searches but I thought I would ask around here to get more accurate responses (just thought I would give it a shot).

 

[WhtsThFrequency]

Thanks for your response, I forgot to ask her about the cost of the meds specifically, we have yet to do the biopsy. I just started freaking out that it's going to be so much money to maintain her treatment that fear I don't know what I'm getting myself into... so I thought I would ask here instead of waiting another week to find out from the Dr.

And as for how they fare on the meds, I have been told by my veterinarian that usually dogs don't do so well on immunosuppressants but I was then told by the dermatologist that dogs she has treated have done well on them. So I was given mixed answers and just thought I would hear stories from a larger pool of people.

I did some google searches but I thought I would ask around here to get more accurate responses (just thought I would give it a shot).

I think it really depends on the dog, the drug, and the dose when it comes to immunosuppressants. I have known dogs that did great and ones that did poorly....I honestly don't know if there is a way to predict. In residency we had dermatopathology rounds with the derm residents/clinicians and it seemed quite a few of their patients with autoimmune skin dz were on them. Azathioprine and cyclosporin (the latter in cats) were the two main ones they used I recall. With azathioprine the biggest concern is bone marrow suppression so there is usually blood testing done relatively frequently at the onset of treatment. I don't know exacts numbers, but it can be somewhat expensive 🙁

 

[Annamalita]

Yeah that's what I was afraid of 😕. I am applying to vet school currently and I do not have a job to fund frequent blood tests and expensive medications. My sister brought up euthanasia but that doesn't sit right with me. My dog is 12 and if it weren't for the skin issues she would still have a qood quality of life and live for at least 4 more years, I think. Its so sad to me to think that euthanizing her would be less expensive than helping her live out the rest of her life. It doesn't even seem like an option to me, it would seem like cruelty to cut her life short just because I don't have the money. This is so hard since I want to help her but I am just getting myself into more debt. 😢

 

[WhtsThFrequency]

Backing up a little, why was she on Pred already if the skin condition hasn't been diagnosed yet? Steroids may still be an option even if it is pemphigus, you might just need some dose tinkering. And they're a lot cheaper than the big guns. Corticosteroids can be used to manage it in some cases; a diagnosis doesn't mean jumping to strong immunosuppressants unless all regular doses and types of steroids have been tried (since cost in an issue)

 

[Annamalita]

Thanks for discussing things with me. I wish she could be okay on the prednisone but infortunately she has been on 5mg pred 2x/day since June and the sores are still persisting. That's why I decided to take her to a specialist. We just did a blood test and her liver values are pretty high from the pred so she needs a different route of treatment. The vet is pretty sure its either vulgaris or bullous pemphigoid or erythema multiforme. Once we get a good biopsy then we should (hopefully) know what she has. I assume the next step after that is immunosupressive drugs. And lots of other blood tests from what you described.

 

[WhtsThFrequency]

Thanks for discussing things with me. I wish she could be okay on the prednisone but infortunately she has been on 5mg pred 2x/day since June and the sores are still persisting. That's why I decided to take her to a specialist. We just did a blood test and her liver values are pretty high from the pred so she needs a different route of treatment. The vet is pretty sure its either vulgaris or bullous pemphigoid or erythema multiforme. Once we get a good biopsy then we should (hopefully) know what she has. I assume the next step after that is immunosupressive drugs. And lots of other blood tests from what you described.

Do you know where the biopsy was sent? If you want a second opinion at any time, I know a fantastic veterinary dermatopathologist who I trained under and can give you the submission info.

 

[Annamalita]

We are currently waiting for the ulcers to get worse (weaning her off of the steroids) to get a good sample. The steroids have been doing *enough* that the Tzanck test was inconclusive..

If you can give me the info, then I can take it to my next appt when we get the biopsy done. In my paperwork it says that she sends it out to PENN... I know I do not have the resources to try to do the biopsy twice. Just sending it out is costing me $260 (3-4samples) with procedural costs not included. Is it possible that the dermatopathologist you recommend is cheaper?

 

[WhtsThFrequency]

We are currently waiting for the ulcers to get worse (weaning her off of the steroids) to get a good sample. The steroids have been doing *enough* that the Tzanck test was inconclusive..

If you can give me the info, then I can take it to my next appt when we get the biopsy done. In my paperwork it says that she sends it out to PENN... I know I do not have the resources to try to do the biopsy twice. Just sending it out is costing me $260 (3-4samples) with procedural costs not included. Is it possible that the dermatopathologist you recommend is cheaper?

Hmmm not sure - I will check and PM you though 🙂

 

[Annamalita]

Thank you so much!

 

[jmo1012]

Thanks for discussing things with me. I wish she could be okay on the prednisone but infortunately she has been on 5mg pred 2x/day since June and the sores are still persisting. That's why I decided to take her to a specialist. We just did a blood test and her liver values are pretty high from the pred so she needs a different route of treatment. The vet is pretty sure its either vulgaris or bullous pemphigoid or erythema multiforme. Once we get a good biopsy then we should (hopefully) know what she has. I assume the next step after that is immunosupressive drugs. And lots of other blood tests from what you described.

is that dose of pred in the immunosuppressive range? i would hope they actually tried an immunosuppressive dose of pred, but 10 mg to a yorkie means a lot more than 10 mg to a great dane

 

[Annamalita]

She is a min pin so shes small :/ but thanks for trying to help!