Lymphocytic cholangitis (LC) is a common feline inflammatory hepatic disease with an unclear cause, rendering treatment challenging. LC affects the biliary tree and progresses slowly over months and years. Histologically, LC resembles primary sclerosing cholangitis (PSC) in humans; ursodeoxycholic acid (UDCA), which has hepatoprotective and immunomodulatory properties, has shown promise in treating human PSC. This study retrospectively characterized feline LC and compared the efficacy of prednisolone to UDCA in cats. Twenty-five cats with LC were treated with either prednisolone (n = 10), UDCA (n = 13), or both (n = 2). Prednisolone at 1 mg/kg q24h (n = 3) or 2 mg/kg q24h (n = 7) was continued for 4–6 weeks, then gradually tapered. UDCA was dosed at 15 mg/kg q24h and continued for the remainder of the cats’ lives. Median survival time was 795 days; survival rates were assessed at 1 (74%), 2 (56%), and 3 (35%) years. Survival times for cats treated with prednisolone at either dose were greater than those for cats treated with UDCA; the group treated with both was too small to attain statistical significance. Larger clinical trials should evaluate different treatments for LC, including the combination of prednisolone with UDCA.
 
Commentary
This study had the common limitations of retrospective studies, but it did suggest that prednisolone is a more effective single-agent therapy than UDCA. As feline LC is an inflammatory disease, it makes sense that a true antiinflammatory agent would be a better single-agent therapy. However, UDCA is an effective ancillary therapy as it helps protect cell membranes, prevents mitochondrial damage, reduces cell destruction and inflammation, and choleresis. Too few cats were evaluated, but evaluation of combined usage of prednisolone and UDCA would be beneficial.—Dara Zerrenner, VMD, MS, DACVIM

Source
Retrospective comparison of prednisolone and ursodeoxycholic acid for the treatment of feline lymphocytic cholangitis. Otte CMA, Penning LC, Rothuizen J, Favier RP. VET J 195:205-209, 2013.

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