Journal watch17 April 2024
Author(s): Dor, C., Nixon, S., Salavati Schmitz, S., Bazelle, J., Černá, P., Kilpatrick, S., Harvey, N.D. and Dunning, M.
Published in: Journal of Small Animal Practice
Date: February 2024
DOI: https://doi.org/10.1111/jsap.13705
Type of access: Open access
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Our summary
Dor, C. et al. (2024) Efficacy and tolerance of oral versus parenteral cyanocobalamin supplement in hypocobalaminaemic dogs with chronic enteropathy: a controlled randomised open-label trial. Journal of Small Animal Practice.
The aim of this randomised control study was to determine whether oral cobalamin supplementation is as effective as parenteral cobalamin supplementation at restoring normal cobalamin levels in dogs with protein-losing enteropathy (PLE), severe chronic enteropathy or severe hypocobalaminaemia secondary to chronic enteropathy. In addition, the study aimed to evaluate ease of administration and tolerance for both types of administration by assessing pet owners’ opinions on the protocols used.
Dogs attending three UK referral centres between August 2018 and April 2020 with clinical signs of chronic enteropathy and hypocobalaminaemia were enrolled in the study. Recruited dogs were randomly assigned to either oral cobalamin supplementation or parenteral cobalamin supplementation. Dogs in the oral supplementation group received cyanocobalamin based on their weight once daily for 12 weeks, equivalent to a minimum dose of 25μg/kg. Dogs in the parenteral supplementation group received a weekly subcutaneous cyanocobalamin injection for six weeks and a seventh dose four weeks later, at a minimum dose of 25μg/kg of cyanocobalamin per injection.
At inclusion and at the end of the study (week 13) dogs underwent a physical examination and body condition score, canine inflammatory bowel disease activity index (CIBDAI) and body weight were assessed. In addition, serum biochemistry, complete blood cell count, serum cobalamin concentration, trypsin-like immunoreactivity, and serum methylmalonic acid concentrations were evaluated. At week 7 physical examination, body weight, serum cobalamin concentration and CIBDAI score were repeated. Treatment failure was defined by recurrence of hypocobalaminaemia at week 13.
For analysis dogs were additionally grouped by the following clinical characteristics: presumptive PLE chronic enteropathy compared to non-PLE chronic enteropathy and moderate to severe hypocobalaminaemia. Owners completed treatment adherence, palatability, tolerance, and satisfaction questionnaires at week 13.
Thirty-seven dogs were included in the study: 18 in the oral cobalamin supplementation group, and 19 in the parenteral cobalamin supplementation group. Nineteen dogs completed the study: 11 in the oral supplementation group and eight in the parenteral supplementation group.
At weeks 7 and 13 serum cobalamin concentrations were significantly higher in the oral supplementation group compared to the parenteral supplementation group. All dogs in the oral supplementation group achieved normal or increased cobalaminaemia at weeks 7 and 13, however one dog in the parenteral treatment group was identified as a treatment failure at week 13, despite reaching eucobalaminaemia at week 7. The mean increase in cobalamin between weeks 0 and 13 was significantly higher in the oral supplementation group compared to the parenteral supplementation group. There was no significant difference in treatment adherence, owner satisfaction, and tolerance scores.
Limitations of the study are the small sample size, that there was a presumed rather than definite diagnosis of chronic enteropathy, the high drop-out rate and the lack of long term follow up. Diet and adjunctive treatments were not controlled at inclusion or during the study period.
Take home
This study provides evidence that oral cobalamin supplementation was well tolerated and was not inferior to parenteral cobalamin supplementation at normalising serum cobalamin concentration in dogs with hypocobalaminaemia due to chronic enteropathy.
The following may also be of interest
Proksch A-L et al. (2025) The effects of age and sex on reference intervals for cobalamin, homocysteine, and serum and urinary methylmalonic acid in healthy adult dogs. Journal of Veterinary Internal Medicine, 39 (1), e17250. https://doi.org/10.1111/jvim.17250
McGinn, A. (2019) In dogs with chronic enteropathies, can oral B12 tablets be used to treat hypocobalaminaemia? Veterinary Evidence, 4 (3). https://doi.org/10.18849/ve.v4i3.202
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