Category: Abstracts

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Update on the treatment of FIP with antiviral drugs in 2025 (Bova)

On July 3, 2025, Bova published updated recommendations for the treatment of FIP with various antiviral drugs. It should be noted that the recommended injection dosage of GS-441524 is missing, as Bova does not produce this active ingredient in injectable form.

Bova is a manufacturer of legal FIP medication, although very few veterinarians in the Czech and Slovak Republics use it due to its high price.

Abstract

Feline infectious peritonitis (FIP) was until recently considered a fatal disease of cats with no effective treatment. However, since 2020, there has been a major breakthrough in the treatment of FIP with the legal availability of antivirals such as remdesivir and its active metabolite GS-441524, initially in Australia and the United Kingdom. This expert review summarizes current recommendations for veterinarians regarding the diagnosis, treatment and monitoring of patients with FIP, and presents the growing clinical experience with individual therapeutic approaches.

The treatment focuses on nucleoside analogues (GS-441524, remdesivir, molnupiravir/EIDD-2801, EIDD-1931), whose mechanism of action is based on the inhibition of viral RNA replication. Oral administration of GS-441524 has been shown to be highly effective even as monotherapy, including in neurological and ocular forms of FIP. The recommended duration of treatment is 12 weeks (84 days), although a shorter 6-week regimen may be considered in cases of early diagnosis and rapid clinical response. Dosage must be adjusted to the individual patient's condition, type of FIP, absorption of the active substance and possible weight gain during treatment.

The document also discusses in detail the possible adverse effects of antiviral drugs (e.g. neutropenia, ALT elevation, gastrointestinal symptoms), recommendations for use in specific cases, and emphasizes the importance of therapeutic monitoring using acute phase proteins (AGP, SAA) and albumin/globulin ratio monitoring. A key caveat is the use of unregulated preparations that may be toxic and of unclear active substance content.

In addition to primary treatment, attention is paid to relapse management, supportive care (including nutrition, analgesia, antiemetics), as well as comorbidities such as immune-mediated hemolytic anemia (IMHA) or myocarditis. Owner support in home care, correct weight-based dosing, and appropriate education are essential for a successful treatment outcome.

In conclusion, FIP now appears to be a treatable disease, with long-term survival rates exceeding 90% with early diagnosis, appropriate treatment, and good compliance, thanks to the availability of quality antivirals and comprehensive management. The aim of this document is to support veterinarians in their professional confidence in the treatment of FIP and to increase the availability of effective treatment for affected cats worldwide.

For those who are only interested in the treatment protocol itself, I am attaching a clear table.

Below you will find the full article in PDF format in English.

fip_vet_update_jul25Download
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Open-label clinical trial of orally administered molnupiravir as first-line treatment for naturally occurring feline effusive infectious peritonitis

Krystle L. Reagan, Terza Brostoff, Jully Pires, Amy Rose, Diego Castillo, Brian G. Murphy

26.9.2024

Original full article:
Open label clinical trial of orally administered molnupiravir as a first-line treatment for naturally occurring effusive feline infectious peritonitis

Abstract

Basic information
Before the discovery of effective antiviral drugs, feline infectious peritonitis (FIP) was a fatal disease of cats. Multiple antiviral treatments have been identified, but optimization of treatment protocols is needed.

The goal
To evaluate the efficacy of PO molnupiravir (MPV; EIDD-2801) in the treatment of effusive FIP.

The animals
Ten cats with naturally occurring effusive FIP and 10 cats from the control group were treated PO with GS-441524.

Methods
Prospective, open-label, longitudinal, comparative study with a reference control group. Ten cats with FIP were enrolled and treated with PO MPV (10–15 mg/kg PO q12h) for 84 days. Cats were evaluated at weeks 0, 6, and 16, and the proportion of cats in clinical remission at week 16 was determined. Survival and clinicopathological characteristics were compared with control cats with effusive FIP treated with PO GS-441524.

The results
Eight of the 10 cats treated with MPV survived and were in remission after 16 weeks. Two cats that did not survive died within the first 24 hours of treatment. No adverse events requiring discontinuation of treatment were observed. Survival of cats treated with PO MPV was not inferior to the historical control group of cats treated with PO GS-441524 (5/9 survived [55 %]), with a survival difference of 25 % (90 % confidence interval, −9.3 % to 59.3 %). Clinicopathological features associated with FIP normalized over the course of the study, and no differences in clinicopathological data were observed at any time point in the study when comparing cats treated with MPV and GS-441524.

Conclusions and clinical significance
Molnupiravir is an effective antiviral treatment for effusive FIP.

The entire study is available in English at https://pmc.ncbi.nlm.nih.gov/articles/PMC11586577/

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GS-441524 and molnupiravir are similarly effective in treating cats with feline infectious peritonitis.

Original article:
GS-441524 and molnupiravir are similarly effective for the treatment of cats with feline infectious peritonitis

Although not registered for feline infectious peritonitis (FIP) in Japan, nucleoside analogues have shown efficacy and have been offered to owners of cats with FIP in our clinic since January 2020. The aim of this study was to examine the outcomes in cats with FIP who received GS-441524 or molnupiravir. The diagnosis of FIP was based on clinical signs, laboratory test results, and the presence of feline coronavirus RNA in blood or exudate. After providing oral and written information, owners of cats with a presumptive diagnosis of FIP were offered antiviral treatment with commercially available GS-441524 starting in June 2020 and with either GS-441524 or molnupiravir starting in January 2022. Dosage was 12.5–25 mg/kg/day for GS-441524 and 20–40 mg/kg/day for molnupiravir, depending on the presence of effusion and neurological and/or ocular signs, and continued for 84 days. A total of 118 cats with FIP (76 with effusion), 59 with GS-4421524 and 59 with molnupiravir were treated. Twenty cats died, 12/59 (20.3 %) in the GS-441524 group and 8/59 (13.6 %) in the molnupiravir group (p = 0.326), with the majority of deaths occurring within the first 10 days of treatment initiation. In the survivors, neurological and ocular signs resolved in all but one cat that had persistent seizures. Of the cats that completed treatment, 48/48 in the GS-441524 group and 51/52 in the molnupiravir group achieved remission. Laboratory parameters normalized within 6 to 7 weeks of drug initiation. Adverse events, such as liver function abnormalities, were transient and resolved without specific intervention. Our data suggest that GS-441524 and molnupiravir have similar efficacy and safety profiles in cats with FIP.

The full article can be found in English at https://doi.org/10.3389/fvets.2024.1422408

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Combination therapy with fluoxetine and the nucleoside analogue GS-441524 shows synergistic antiviral effects against various SARS-CoV-2 variants in vitro

Complete original article: Combination Therapy with Fluoxetine and the Nucleoside Analog GS-441524 Exerts Synergistic Antiviral Effects against Different SARS-CoV-2 Variants In Vitro81 /

Authors: Linda Brunotte, Shuyu Zheng, Angeles Mecate-Zambrano, Jing Tang, Stephan Ludwig, Ursula Rescher, and Sebastian Schloer

Abstract

The ongoing SARS-CoV-2 pandemic requires effective and safe antiviral treatment strategies. Drug repurposing is a fast and inexpensive approach to developing new treatment options. The direct antiviral agent remdesivir was found to have antiviral activity against SARS-CoV-2. While remdesivir has only a very short half-life and bioactivation, which depends on prodrug activating enzymes, its plasma metabolite GS-441524 can be activated by various kinases, including adenosine kinase (ADK), which is moderately expressed in all tissues. The pharmacokinetics of GS-441524 suggest that it is a suitable antiviral drug that can be administered to patients with COVID-19. In this work, we analyzed the antiviral properties of combination therapy with the metabolite remdesivir GS-441524 and the antidepressant fluoxetine in a polarized Calu-3 cell culture model against SARS-CoV-2. Combination therapy with GS-441524 and fluoxetine was well tolerated and showed synergistic antiviral effects against the three circulating SARS-CoV-2 variants in vitro in commonly used drug interaction reference models. Thus, combination treatment with GS-441524 virus-targeted and host-targeted fluoxetine could offer a suitable therapeutic option for the treatment of SARS-CoV-2 infections.

Translator's note: Fluoxetine is produced under various trade names, of which Prozac is probably the best known.

… You can read the rest in complete article in english.

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The preclinical inhibitor GS441524 in combination with GC376 effectively suppressed SARS-CoV-2 proliferation in the respiratory tract of mice.

You can find the whole article on the server biorxiv.org;
13.11.2020.

Abstract

The unprecedented coronavirus disease pandemic of 2019 (COVID-19) caused by the second severe acute respiratory syndrome virus (SARS-CoV-2) poses a serious threat to public health worldwide. There is an urgent need to develop effective therapies against SARS-CoV-2. We evaluated the antiviral activity of the original remdesivirus nucleotide analog, GS441524, which targets the enzyme RNA-dependent RNA polymerase, and the protease inhibitor GC376, which targets the protease SARS-CoV 2 in infected mice. Our results showed that GS441524 effectively blocked SARS-CoV-2 proliferation (multiplication) in the upper and lower airways with combined intranasal (in) and intramuscular (im) therapy. The efficacy of the high dose of GC376 (im or in and im) was weaker than GS441524. However, it is noteworthy that the combined administration of GS441524 together with GC376 at low doses could effectively protect mice from SARS-CoV-2 infection during in or in and their treatment. We further found that the pharmacokinetic properties of GS441524 were superior to GC376, and the combined application of GC376 and GS441524 had a synergistic effect. Our findings will be used to further evaluate the combined application of GC376 and GS441524 in future clinical trials.

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Candidate gene markers associated with fecal secretion of feline enteric coronavirus (FECV)

Complete original article on portal of the US National Center for Biotechnology Information; 17.11.2020

Abstract

Feline coronavirus (FCoV) can cause a fatal disease - feline infectious peritonitis. Cats that permanently shed this virus are the most important sources of infection. The role of the host in faecal excretion of FCoV is unknown. The aim of this study was to identify gene markers and test their association with FCoV secretion patterns. Fecal samples were taken from 57 cats of 12 breeds at baseline and then at 2, 4 and 12 months. Variations from persistent and / or high intensity excretion to no excretion were observed. Thirteen immune-related genes were selected as functional and positional / functional candidates. Positional candidates were selected in the candidate area detected by GWAS analysis. Tens to hundreds of single nucleotide polymorphisms (SNPs) per gene have been identified by next generation sequencing. Associations with different phenotypes were evaluated by chi-square tests and Fisher's exact tests. SNP of one functional and one position candidate (NCR1 and SLX4IP ) and haplotypes of four genes ( SNX5 , NCR2 , SLX4IP , NCR1 ) were associated with FCoV excretion at p cor<0.01. Highly significant associations have been observed in extreme phenotypes (persistent / high-intensity secretors and non-excretors), suggesting that there are two major phenotypes associated with different genotypes - highly susceptible cats that persistently excrete high levels of viral particles, and coronavirus-resistant cats. do not exclude.

Keywords: feline enteric coronavirus, faecal excretion patterns, polymerase chain reaction, genetic susceptibility, candidate immune-related genes, association study

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Clinical efficacy of itraconazole and prednisolone combination therapy in the treatment of feline infectious peritonitis

Satoshi Kameshima, Yuya Kimura , Tomoyoshi Doki , Tomomi Takano , Chun-Ho Park , Naoyuki Itoh

Original article in National Library of Medicine, 27.8.2020

Abstract

A 3-month-old Scottish Fold cat with pleural fluid and a low albumin to globulin ratio (A / G ratio) was brought to our small animal hospital. Because feline coronavirus type I (FCoV) RNA was detected in pleural fluid, the cat was pre-diagnosed with an fusion form of feline infectious peritonitis (FIP). After administration of itraconazole and prednisolone, the A / G ratio increased and the pleural fluid almost disappeared. Fecal FCoV levels have temporarily decreased. However, the cat began to show neurological symptoms, and we eventually had to proceed to euthanasia due to the persistent epileptic condition after 38 days of treatment. In conclusion, itraconazole has been shown to be beneficial in the treatment of cats with FIP. However, further investigation of the possible role of itraconazole in the treatment of FIP is needed.

Keywords: feline infectious peritonitis; itraconazole; neurological manifestation; pleural fluid; feline coronavirus type I.

Note: On the Slovak or Czech market, itraconazole contains, for example, drugs called Conisor, Sporanox, Procanazole. They are usually used to treat fungal infections, e.g. nails.

You can get an idea of dosing in cats in A clinical study on the use of itraconazole in the treatment of FCoV.

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Mutian®X oral form has stopped fecal coronavirus excretion in naturally infected cats

Original complete article: Oral Mutian®X stopped faecal feline coronavirus shedding by naturally infected cats (June 2020)
Abstract translation: 17.1.2021

Diane D Addie, Sheryl Curran, Flora Bellini, Ben Crowe, Emily Sheehan, Lesya Ukrainchuk, Nicola Decaro

Abstract

Feline coronavirus (FCoV) is common in domestic cats living in groups. About 10% infected cats can potentially develop a fatal disease, feline infectious peritonitis (FIP). The virus is transmitted by the faecal-oral route. Mutian® Xraphconn (Mutian X) is a product for the treatment of FIP, but it is also used to stop coronavirus secretion, although there are no clear guidelines for its use. The aim of this study was to determine the minimum dose and duration of treatment required to reliably eliminate the virus in the faeces of asymptomatic, virus-secreting cats. In five households with several cats, Mutian X tablets received 29 cats naturally infected with FCoV, and actively shedding the virus in the feces. Virus shedding was monitored by a quantitative reverse transcription polymerase chain reaction (RT-qPCR) controlled on fecal inhibitors to ensure susceptibility. Mutian X administered orally eliminated the virus in 29 cats; although four cats required re-therapy to stop virus shedding. A dose of 4 mg / kg every 24 hours for four days was found to be the optimal treatment protocol: 2 mg / kg cleared only 80% cats. Therapeutic use of a sensitive RT-qPCR assay was necessary to ensure that virus was eliminated, as failure of even one cat could result in re-infection of other cats. Pre-treatment virus shedding records provided retrospective control: significantly more cats stopped shedding virus after Mutian X than recovered from infection during the control period (p <0.00001). This is the first report of successful elimination of FCoV excretion by the faecal route in chronically infected cats.

Keywords: Antivirals; Faecal shedding of the virus; Feline coronavirus (FCoV); Feline Infectious Peritonitis (FIP); Itraconazole; Mutian X tablets

Copyright © 2020 Authors. Published by Elsevier Ltd. All rights reserved.

Translator's note: To achieve the same effect, any drug containing GS441524.

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Detection of Ascitic Feline Coronavirus RNA from Cats with Clinically Suspected Feline Infectious Peritonitis

Original article published on the portal National Center for Biotechnology Information
13.10.2013

Abstract

Ascitic feline coronavirus (FCoV) RNA was examined in 854 cats suspected of having feline infectious peritonitis (FIP) by RT-PCR. Positivity was significantly higher in purebreds (62.2%) than in hybrids (34.8%) (P <0.0001). Among purebred breeds, the positives of the Norwegian Forest Cat (92.3%) and the Scottish Fold cat (77.6%) were significantly higher than the average of purebred breeds (P = 0.0274 and 0.0251, respectively). Positivity was significantly higher in males (51.5%) than in cats (35.7%) (P <0.0001), whereas the prevalence of anti-FCoV antibodies generally showed no gender difference, suggesting that FIP in males infected with FCoV is more common, so males are more likely to break FIP. Genotyping was performed on 377 gene positive samples. Type I (83.3%) was detected much more frequently than type II (10.6%) (P <0.0001), similar to previous serological and genetic surveys.

See for more information original article. Among other things, it is mentioned that the incidence of FIP shows seasonal changes, and most often occurs in the autumn and winter months, while in summer the incidence is significantly lower.

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