A New Medication to Help Manage Weight Loss in Cats - Elura™
by Jenny Alonge
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Thirty percent of cats older than 10 suffer from chronic kidney disease. Weight loss typically occurs before diagnosis, and continues to debilitate the cat as the disease progresses. Decreased appetite, malabsorption, and increased energy requirements contribute to weight loss. Significant body weight decreases negatively impact a cat’s survival chances by causing energy loss, and immune function and muscle deterioration. Their survival chances can also be indirectly affected, because cat owners are more likely to opt for euthanasia if their cat exhibits significant weight loss. In October 2020, the United States Food and Drug Administration approved Elura™, a new prescription medication, to manage weight loss in cats with chronic kidney disease.
Chronic kidney disease in cats
Chronic kidney disease occurs when functional renal tissue is lost over a prolonged period, typically two months or more. The condition can remain undetected for months or years, especially in cats, who are notorious for hiding their vulnerabilities. Initially, cats usually show no signs, but as the disease progresses, signs will include lethargy, weight loss, unkempt appearance, polyuria, and polydipsia. The International Renal Interest Society (IRIS) developed a four-stage system, based on serum creatinine and symmetric dimethylarginine (SDMA) measurements, to help veterinarians diagnose and manage chronic kidney disease. The stages are:
- At risk — Serum creatinine is less than 1.6 mg/dL and SDMA is less than 18 ug/dL; age, breed, or exposure to a nephrotoxic agent put the cat at risk.
- Stage 1 — Serum creatinine is less than 1.6 mg/dL and SDMA is less than 18 ug/dL; the cat is nonazotemic, but another renal abnormality is present.
- Stage 2 — Serum creatinine is between 1.6 and 2.8 mg/dL and SDMA is between 18 and 25 ug/dL; the cat has mild renal azotemia, but clinical signs are usually absent.
- Stage 3 — Serum creatinine is between 2.9 to 5 mg/dL and SDMA is between 26 and 38 ug/dL; the cat has moderate renal azotemia, and the severity of clinical signs varies.
- Stage 4 — Serum creatinine is greater than 5 mg/dL and SDMA is greater than 38 ug/dL; the cat has severe azotemia and likely exhibits clinical signs.
How Elura™ helps cats affected by chronic kidney disease
Elura is produced by Elanco Animal Health Incorporated, which also produces a similar product, ENTYCE, for appetite stimulation in dogs. Elura is a capromorelin oral solution for use in cats only. Capromorelin is a selective ghrelin receptor agonist that binds to receptors in the hypothalamus to stimulate appetite. The drug also binds to receptors in the pituitary gland to stimulate growth hormone secretion. Insulin-like growth factor is released from the liver, because of the Increase in growth hormone production, stimulating weight gain. Weight gain in cats taking Elura is thought to be caused by increased food intake and metabolic changes. Elura is administered orally at 2 mg/kg body weight once daily. Cats should be offered food 30 minutes after receiving Elura. If the cat vomits in 15 minutes, or receives only a partial dose, the medication can be re-administered.
Elura’s effectiveness was demonstrated in a masked, randomized field study. One hundred and seventy six client-owned cats with chronic kidney disease who exhibited greater than 5 percent unintended weight loss were enrolled in the study. The cats were given Elura at 2 mg/kg, or the solution without the drug at an equal volume for control cases, once daily for 56 days. The cat’s body weight from day zero to day 55 was the primary effectiveness variable. A statistically significant difference (+5.2%) between the Elura group and the control group (-1.6%) was observed on day 55. Cats evaluated for weight in the Elura group on day 15 also demonstrated significant change, indicating that weight gain occurred throughout the study. Also, a six-month safety study was performed on 32 healthy, domestic shorthair cats. The cats were dosed using Elura or water at one, three, or five times the recommended labeled dose. The Elura groups receiving three and five times the labeled dose consumed more food than cats in the control group.
Possible adverse effects seen in cats taking Elura™
The most common side effects seen during the field and safety studies were vomiting and hypersalivation. The hypersalivation was typically caused by dosing and resolved quickly. Other adverse effects included:
- Inappetence
- Behavior change
- Lethargy
- Anemia
- Dehydration
- Diarrhea
- Urinary tract infection
- Hyperglycemia
- Ataxia
Elura can cause decreases in heart rate and blood pressure for up to four hours following administration, and should not be used in cats affected by cardiac disease or dehydration. Since Elura stimulates excess growth hormone secretion, cats affected by hypersomatotropism also should not receive this medication. Elura is metabolized in the liver, so caution should be used when administering this drug to cats affected by hepatic dysfunction. Elura can increase serum glucose for several hours after administration and is likely not appropriate for cats with diabetes mellitus. Elura’s safety has not been evaluated in cats younger than 5 months, or in cats who are pregnant, lactating, or intended for breeding.
Elura provides veterinarians with another tool to fight chronic kidney disease in cats. By managing their weight loss, cats with this debilitating disease can live longer, better quality lives. This means that cat owners can spend more valuable time with their cat, without sacrificing their cat’s well-being.
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