An 11-year-old neutered male Pomeranian with diabetes mellitus (well controlled for 2 years with q12h NPH insulin and a high-fiber diet) is presented with intermittent inappetence, small-bowel diarrhea, and weight loss of 2 months duration. There is no history of diet change/indiscretion or known infectious disease exposure. Physical examination, CBC, serum chemistry profile, serum fructosamine, urinalysis, baseline cortisol, cPLI test, and abdominal imaging (radiography and ultrasonography) rule out diabetic dysregulation, pancreatitis, GI obstruction, and hypoadrenocorticism. Fecal analysis findings are unremarkable. Signs do not resolve with empiric anthelmintic (ie, fenbendazole) administration, additional dietary fiber, antibiotic administration, and an 8-week limited-antigen diet trial. Endoscopy is performed; endoscopic intestinal biopsies show lymphoplasmacytic enteritis, and inflammatory bowel disease (IBD) is diagnosed.
Which of the following drugs would be appropriate in the management of this patient?
ACTH = adrenocorticotropic hormone, cPLI = canine pancreatic lipase immunoreactivity, IBD = inflammatory bowel disease