pschatz4

One of the advantages of the medicine we are working to develop is that we plan to give it by subcutaneous injection. IMO, this is much easier with cats and dogs than trying to get them to swallow a pill. Just pinch up some skin, inject under your fingers, and many animals (especially cats) hardly notice. After getting trained by your vet (of course), you can easily do this at home just like many diabetics do to self-administer insulin. Having tried to give pills to cats (ouch...), I think this will work better for all concerned.

I tried that approach with our cat, Phred, who allowed my family to share his house when I was a teenager. I had only occasional success, so hats off to your pilling technique. Phred would squirm at just the wrong moment, the pill would move to the side of his tongue, and then he would (triumphantly) spit it out a few moments later.

Yes, please get trained by a vet. Let's avoid needle sticks.

Here some related scientific background on what we are doing: The company I worked for before joining Companion Sciences, Affymax, discovered, developed, and obtained FDA approval for a human drug (called Omontys or peginesatide) to treat anemia in adult human kidney dialysis patients. I first got to know Nicole and Tom when they contacted me to ask if they could try peginesatide for their cat Cassie. Sadly, I had to tell them that, in this case, the human drug didn't work in cats (or dogs). Many human drugs do work, but peginesatide didn't. It does work in mice, rats, pigs, monkeys, rabbits, (and humans of course), but not in cats and dogs. My colleagues and I at Affymax looked into this and found that there is a small change in the cell surface receptor for EPO in cats, dogs, and other members of the Carnivore Family, that prevents the drug from working. That led to the idea: since we can't change all the cats and dogs, why not change the structure of the drug a bit so that it will work in cats and dogs. Starting from that idea, we have already made substantial progress and now have new structures that do bind to the cat/dog receptors.

The relationship between hemoglobin (a measure of red blood cell levels) and patient health/well-being is, as you point out, a much-discussed topic in the kidney disease/anemia field. The guidelines that you work under are set by bureaucracies that can't really deal with the patients on an individual basis like you do. I think that the people on the front lines of this issue, like yourself, need to focus on the individual needs of each patient. Some patients feel fine at an hemoglobin level of 8. Others feel terrible at 12. Right after I donate blood, I'm at about 14 and I usually feel light-headed for a while. The critical thing for patients is to be treated as individuals so that they are dosed to reach a level right for their needs. The research says that ESRD patients, considered as a group, have higher levels of cardiovascular problems when you push their hemoglobin levels up towards 12. That's why the guidelines changed. If I was an ESRD patient, and I felt crappy at a hemoglobin of 10, I would want to be dosed to a higher level. If that slightly increased my probability of having a stroke, so be it. I would rather live a shorter time feeling well than a long time lying around feeling terrible. In the case of our furry friends, I think we have a better chance of being appropriately flexible. The decisions about pet care are usually made by the owners in direct consultation with their vet. No bureaucrats need apply.