Off-Label Use of Crisdesalazine (GedaCure) in Meningoencephalitis in Two Dogs

SIMPLE SUMMARY: Crisdesalazine is a multi-targeted drug with antioxidant and anti-inflammatory action to prevent amyloid plaque, neurofibrillary tangle, and neurodegeneration that cause dementia. We tried this drug on meningoencephalitis of unknown origin in dogs, expecting the improvement of their neurologic signs. In Case 1, the dog was tentatively diagnosed with meningoencephalitis of unknown origin by MRI and has started treatment with prednisolone and cytarabine. However, recurrent severe bacterial cystitis has occurred, suspected as the side effect of immunosuppressants. After adding crisdesalazine in ongoing therapy, the patient could reduce the dosage of the drugs successfully. In Case 2, the dog was tentatively diagnosed with meningoencephalitis of unknown origin through its history using clinical signs, blood analysis, neurologic examination, magnetic resonance imaging, and cerebrospinal fluid analysis. The dog has started treatment with cytarabine, prednisolone, and levetiracetam and the alleviation of the clinical signs was inadequate. However, after adding crisdesalazine in ongoing treatment, the neurologic signs of the dog were markedly improved. To the best of our knowledge, no previous report has documented clinical cases of reduced neurological signs in dogs with meningoencephalitis of unknown origin after adding crisdesalazine as an adjunct to ongoing immunosuppressive treatment. ABSTRACT: An 8-year-old, castrated male Shih-tzu dog (Case 1) showing ataxia and gait disorder was referred for neurological examination and magnetic resonance imaging. Through comprehensive examinations, the patient was tentatively diagnosed with meningoencephalitis of unknown origin (MUO) and treatment with prednisolone and cytosine arabinoside was started. The symptoms were improving with immunosuppressive treatment. However, severe bacterial cystitis occurred and we could not avoid tapering off prednisolone. Then, neurological signs recurred. Therefore, we added crisdesalazine, which allowed us to reduce the daily dosage of immunosuppressants easily. In another case, a 4-year-old, spayed female Yorkshire terrier dog (Case 2) was referred to our hospital showing a head tilt, circling, and loss of the menace reflex. The patient was tentatively diagnosed with MUO and treatment with some immunosuppressants was attempted. The clinical symptoms improved, but the alleviation was inadequate. Thus, we added crisdesalazine. The neurological signs then markedly improved. Moreover, the drugs could be tapered off more easily than before. Crisdesalazine is a novel drug that has antioxidant and anti-inflammatory action in brain disease and is used particularly for dementia. In this paper, we tried an off-label use of this drug in canine MUO patients, and found that it had, in these two patients, additional therapeutic effects on the MUO.