{"id":16822,"date":"2019-06-25T19:16:55","date_gmt":"2019-06-25T19:16:55","guid":{"rendered":"https:\/\/todaysveterinarypractice.com\/?p=16822"},"modified":"2022-11-18T15:10:08","modified_gmt":"2022-11-18T15:10:08","slug":"the-use-of-capromorelin-for-the-clinical-problem-of-inappetence","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/pharmacology\/the-use-of-capromorelin-for-the-clinical-problem-of-inappetence\/","title":{"rendered":"The Use of Capromorelin for the Clinical Problem of Inappetence"},"content":{"rendered":"

Inappetence is a common clinical sign that has an important influence on perceived quality of life and case management in dogs and cats. Prolonged inappetence can negatively affect patient nutritional status, clinical outcome, and, potentially, survival.<\/p>\n

Capromorelin oral solution (Entyce; Aratana Therapeutics, aratana.com<\/a>) was approved by the Food and Drug Administration (FDA) in May 2016 for appetite stimulation in dogs and became available to veterinarians in the fall of 2017. Although further studies are needed to fully define the ideal use of this product in veterinary practice, capromorelin has the potential to positively affect the clinical management of inappetence and weight loss\/cachexia in dogs (and, off-label, cats) with many different medical conditions. This article provides an overview of capromorelin\u2019s mechanism of action, safety and efficacy data, and potential clinical roles.<\/p>\n

Background<\/h2>\n

Capromorelin oral solution is an orally active small-molecule ghrelin receptor agonist (GRA) that mimics the action of endogenous ghrelin, resulting in growth hormone secretion and appetite stimulation.1-4<\/sup> Given its effect on growth hormone and, subsequently, insulin-like growth factor-1 (IGF-1) levels, capromorelin may also have a clinical role in treating cachexia.2,5<\/sup><\/p>\n

Capromorelin is the first GRA approved by the FDA for a therapeutic purpose in any species.6<\/sup> Due to the limited inappetence treatment options available for cats, it may be considered for off-label use in cats that do not respond to the FDA-approved therapy mirtazapine<\/a> transdermal ointment (Mirataz; Kindred Biosciences, kindredbio.com<\/a>).7<\/sup> Ideal integration of capromorelin into clinical case management for both short- and long-term inappetence is still being defined.<\/p>\n

Clinical Challenge Of Inappetence<\/h2>\n

Reduced appetite is a nonspecific clinical sign with myriad acute and chronic physiologic causes (TABLE 1<\/strong>). Signs are often subtle, subjective, and highly dependent on client and clinician observations. The observed decrease in appetite is often broadly described in severity along a spectrum from anorexia (complete loss of appetite) to hyporexia (decreased appetite, not consuming full caloric needs). Dysrexia\u2014any level of altered eating pattern (e.g., eating, but not the desired diet)\u2014can also span this clinical spectrum.8,9\u00a0<\/sup>Inappetence<\/em> is an overarching term that is used in this article to encompass decreased and\/or altered appetite\/food intake.<\/p>\n

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Given the wide variety of clinical conditions that can lead to inappetence, it is no surprise that inappetence has been reported as the most common presenting problem (8.5%) for patients evaluated in the small animal primary care setting.10\u00a0<\/sup>This highlights the critical role that a good appetite plays when pet owners evaluate the overall quality of life for their dog or cat.11,12\u00a0<\/sup>Inappetence at time of admission has been associated with a higher risk of death in hospitalized dogs,13\u00a0<\/sup>and inappetence has been shown to be a key variable in a client\u2019s end-of-life decision for their dog or cat.14\u00a0<\/sup><\/p>\n

BOX 1 Nonapproved Medical Treatments Considered for Inappetence in Dogs<\/div>
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