International cat day (8 August) is reason for special celebrations this year in Belgium and Italy, where veterinary treatment for cats with feline infectious peritonitis (FIP) has become possible in the past months. Treatment for this fatal disease has been ‘around’ for some years now but due to a lack of a licensed veterinary product, the black market has flourished.
Belgium authorises the use of remdesivir
In Belgium, remdesivir has become legally available to veterinary practitioners - and so has GS-441524, as announced by SAVAB on its website late March. ‘While GS-441524 has no marketing authorisation in Belgium, it can be prescribed as extemporaneously prepared medication, in accordance with EU legislation,’ Laurence De Meester, president of SAVAB notes in the June edition of Veterinaria, journal of the Union professionnelle vétérinaire of Belgium, referring to article 105 of the EU Regulation 2019/6.
...and GS-441524 in cats with FIP
After consultation with the Federal agency for medicines and health products, ‘Belgian veterinarians have been allowed to prescribe an extemporaneous preparation of GS-441524, for a specific cat owner and for a certain duration.' The prescription is valid in the entire EU, and the preparation must be in accordance with Belgian legislation on the quality and control of raw materials for medicinal preparation. Currently ‘only pharmacy Delpech in Paris is qualified, and proposes GS-441524 in the form of and oral paste or solution,' SAVAB notes, adding that other pharmacies might follow suit.
Italy: remdesivir authorised
In Italy, the Ministry of Health has authorised the use of remdesivir (Veklury°) for the treatment for FIP in cats ‘by way of derogation’ and ‘in accordance with EU legislation,' i.e. through Implementing Regulation (EU) 2024/1973. Vets can prescribe the drug exclusively for cats with FIP while pharmacists - the only ones that can legally dispense medicines in Italy - must order the product directly from the manufacturer Gilead. However, no authorisation for the prescription of GS-441524 has been given.
… but not GS-441524
As remdesivir can only be administered intravenously, Italian MEP Susanna Cherchi asked the Ministry of Health on 3 July whether it is ‘considering the authorisation’ of the use of remdesivir’s active ingredient GS-441524, which can be given orally at a potentially lower costs, ‘and is recognised by international scientific communities as effective in the treatment of FIP.' She added that some European countries allow their vets to order it from compounding pharmacies in the UK or France. No answer has been received to date.
European vets call for a legal treatment option
In 2023, FVE and FECAVA held a joint webinar on the treatment of FIP. A brochure summarising the main findings is regularly updated. ‘We are urging policymakers to provide veterinarians with a legal option to treat FIP-affected cats,’ stresses Ann Criel, board member of FECAVA and UEVP. Currently, GS-441524 is not licensed and not marketed for veterinary use in Europe. However, it is available as an extemporaneous product in certain countries, while others, like Belgium, allow importation of these products.
FIP, a complex diagnosis
The diagnosis of FIP is highly complex, she noted. ‘At the moment, many desperate cat owners are sourcing treatment of unknown quality on the black market – for cats that may not even have the disease. For the wellbeing of cats, it is essential that vets are in the position of diagnosing and treating, especially now that a cure is possible.' 'I fully agree, added Volker Moser, UEVP president. 'We need to resolve this issue for practitioners - and cats - as soon as possible.'
Resources
Veterinary resources on the disease, including diagnosis and treatment – which varies depending on the disease form and clinical response – are regularly updated on the website of the Advisory Board on Cat Diseases (ABCD). Excellent owner resources can be found here.
(photo © Sarawuth Tejawong/Pixabay)