Is combination therapy effective?
Dr. Mazzaferro noted that “at this time, there are no studies to support combination therapy of other immunosuppressive agents with glucocorticoids versus administration of glucocorticoids alone.” According to the American College of Veterinary Internal Medicine guidelines2 for treating IMHA, a second drug may be added if the patient is very severely affected on presenta-tion, packed cell volume does not stabilize within seven days, the dog continues to be transfusion dependent over seven days or the patient is having severe adverse effects from steroids. The choice of which drug to add may be based on several factors:
- How quickly you want the second drug to start working (i.e., how quickly you want to start weaning prednisone or how quickly you want the immune system suppressed — maybe faster with a severely affected cocker spaniel, for example)
- What is available
- What the internist you consult with recommends