[Image Source]

FIP Drug Access: Canada

Great news for Canadian veterinarians, cat owners and cats: We now have legal access to drugs that can treat feline infectious peritonitis (FIP), a disease that’s historically been considered almost invariably fatal in cats, prior to the discovery of these very treatments.

I’ll keep this short (-ish… since Moe keeps complaining about my long posts).

We’ve known for a few years that the antiviral drugs remdesivir and its close relative GS-441524 (and to a lesser degree molnupiravir) can be highly effective for treating FIP, with really high cure rates, although the drugs are extremely expensive.

But the biggest problem has been drug access. None of these drugs are licensed for animals in Canada.

The two drugs licensed for use in humans (remsidivir and molnupiravir) technically could be imported for veterinary use based on an Emergency Drug Release (EDR) if purchased directly from a manufacturer, but the manufacturers would not agree to this. So for the past few years, people have been purchasing and illegally importing black market drugs and using them to treat their cats themselves, because without these drugs most cats with FIP will die. Sometimes owners were lucky to have some veterinary support, sometimes they did not. Veterinarians can’t recommend or give an illegal product to a patient, but in some cases could at least provide some supportive care through the process. It’s a really tough situation for everyone involved.

Legally compounded remdesivir and GS-441524 have been available in Australia, the UK and South Africa, but we were not able to access those products either – until now. Working with Health Canada’s Veterinary Drugs Directorate (VDD), we’ve been able to get their approval to import legally compounded versions of both these drugs from the UK. Veterinarians have to request permission to import the drug via an EDR every time they want to use it (i.e. they can’t import a supply to keep in the clinic for when they need it, it needs to be requested for each patient), so there are still some logistical hoops to jump through, but ultimately they’re not a big deal. The drugs still aren’t cheap either, but probably cheaper than what I’m hearing most people are paying for the illegal versions (that also have no assurance of quality control or safety).

To veterinarians:

We’ve developed guidance documents about treatment regimens and the EDR process to help make these treatments more widely accessible. Contact me directly or through the blog’s contact link (in the menu bar at the top of the page) to get access to those. We’ll try to keep everyone up-to-date on changes to treatment regimen recommendations as we go, as this is a fairly new and therefore dynamic field.

To cat owners:

These drugs need to be imported by a veterinarian who has a veterinarian-client-patient relationship (VCPR), meaning the veterinarian who is your cat’s healthcare provider. They cannot be imported by cat owners, and they cannot be imported by veterinarians for sale to non-clients, or for use on cats that are not their patients.

We will be working with veterinarians to help them treat cats with FIP, but we cannot work directly with cat owners. If you have a cat that might have FIP, you need to work with your local veterinarian, or ask for a referral to a veterinarian who can offer the treatment.

If you’re in the US, Canadian veterinarians cannot import this drug to ship to the US. It is for cats being treated by Canadian veterinarians. As far as I know, there is still no ability to import these products into the US (hopefully that will change soon too).

This is a great example of what needs to be done to tackle infectious diseases, especially in minor species (particularly non-food animals) and smaller markets (like Canada) where lack of access to important treatments, vaccines or other products in general is a much broader issue, but one that’s been flagged repeatedly as an important area to address. This is a small but important example of what can be done when companies, veterinarians and regulators work together to find solutions.

I had to drive to a hospital in Ottawa because my vet would not receive the drug in time. It cost around $3000 CAD for a 6 month old, 2lb cat. This was just for the medication (1 months worth) not including the cost of imaging, bloodwork and overnight stays.