Frequently Asked Questions About FIP

NO!  As of February 2019, there is significant hope for cats with any form of FIP.  While not yet approved by the FDA, thousands of cats around the world have used GS441 from China and have been clinically cured of feline infectious peritonitis.

As of February 2019, yes!  Thousands of cats have used GS441 from China and have been clinically cured of feline infectious peritonitis.  GS441 has effectively cured wet FIP, dry FIP, ocular and neurological FIP.  GS441 comes in both oral and injectable form. The treatment protocol calls for 12 weeks of daily administration of the drug. Most cats see significant improvement of physical symptoms within the first 1-3 days, but require the full course of treatment to fully eradicate the virus.  More info can be found at FIP Warriors (facebook group).

It is not yet approved by the FDA and therefore not available for sale through pharmaceutical companies; however, there are several manufacturers in China whose product has been tested and found to be identical to that which was used in the case studies.  As of July 2019, over 2000 cats all over the world have been completely cured using the GS441 from China.  For more info, search and join “FIP Warriors 5.0” on Facebook. 

No.  What is sometimes called (incorrectly) and “FIP test” is actually an FCoV titer test.  This test can show if the cat has been exposed to the coronavirus, but is in NO WAY indicative of FIP. 

A proper FIP diagnosis requires a combination of diagnostics, including but not limited to: physical exam, complete blood count, RT-PCR of effusion (wet FIP), and  PCR (RT-qPCR) on fine-needle aspirates (dry FIP). 

Read more about how to diagnose FIP here.

Technically yes, though it is highly controversial.  The 2000 Report of the American Association of Feline Practitioners and Academy of Feline Medicine Advisory Panel on Feline Vaccines states that “at this time, there is no evidence that the vaccine induces clinically relevant protection, and its use is not recommended.” 

No.  The coronavirus is highly contagious and most cats will be exposed to it at some point during their life.  FCoV is shed through feces, so cats who share a litter box or groom one another are exposed to the benign form of the virus.  Cats who have a healthy immune system will pass the coronavirus with little to no issue other than a bout of diarrhea and/or cold-like symptoms.

Cats who have a weakened or not fully developed immune system may not be able to pass the coronavirus, and the virus mutates into FIP.  Once mutated into FIP, the virus is no longer contagious. 

There is believed to be a genetic component with FIP, so biological litter mates may share the same genetic predisposition that allows FCoV to mutate.  A family history of FIP does unfortunately increase the likelihood that siblings will develop FIP.     

FCoV is passed via feces, and there is anecdotal evidence to suggest it can be passed via saliva.  If a cat in your household has the coronavirus or FIP, litter boxes should be sterilized with a mix of bleach and hot water, or replaced with new.  Food & water bowls, toys, and beds should be thoroughly washed or replaced.  Larger items such as kitty-condos or cat trees can be sanitized by placing in direct sunlight for 24 hours. Hard flooring should be thoroughly cleaned with bleach/hot water.  Soft surfaces such as carpeting or upholstered furniture should be steam cleaned. FCoV can live in carpets and soft surfaces for as much as seven weeks.       

Other cats in the household cannot catch FIP (see FAQ: Is FIP contagious, above).  The best protection you can give other cats in the household is to support their immune system. Healthy cats with a strong immune system will pass and clear the coronavirus.  Moducare is a highly recommended immune-booster, as is first milking, liposomal delivered Colostrum.  

There’s no certain answer here.  FIP can affect an entire litter, a single kitten, or anything in between.  While litter mates don’t “catch” FIP from each other, they can share a genetic predisposition that allows the coronavirus to mutate into FIP.  If any kitten in the litter has FIP, providing immune support for the rest of the litter gives them the best chance at staving off FIP.  (Also see FAQ: how can I protect my other cats from FIP if one has it, above, for recommended immune boosters.) 

FCoV is a relatively fragile virus and if you follow the advise under How to get rid of FCoV in your home (above), it’s likely that your house will be free of FcoV within a few days. Normal exposure to air and sunlight will usually destroy the coronavirus within two weeks. That said, it is recommended to wait at least a month and ideally seven weeks, especially if your home is carpeted,  before introducing a new cat. Adopting an older cat (2 years or older) can also ensure that the new cat has a fully developed immune system. 

If you have other cats in the household who were exposed to your FIP cat, it is recommended that you test them for FCoV antibodies every 3-6 months to determine if they are shedding the virus.  When your remaining cats’ antibody titers return to zero, it is safe to introduce a new cat.

Remember to test the new cat for FCoV antibodies also, to ensure that the new cat is not re-introducing FCoV to your home. 

Pumpkin puree is very effective for both diarrhea and constipation.  The soluble fiber in pumpkin will regulate and deliver the correct amount of water to the GI tract.  It’s also packed with vitamins that are beneficial to cats, and most cats will eat pumpkin voluntarily if stirred into their food.  There’s no harm in adding some to every meal, as a preventative either.  Be sure it is pure pumpkin puree, NOT pie filling.    

Another option is a probiotic, such as Fortiflora which promotes proper gut health and enhances the immune system. This is an excellent addition to any cat’s diet, and can be given daily indefinitely. 

Dabbing some isopropyl rubbing alcohol on the pads of a cat’s paws can help reduce a fever quickly.  If kitty is willing to sit still for a bit, you can also wrap an ice pack in a towel and rest it against his or her body. A fan can also help reduce a fever but again, only if the cat is fairly sedentary and stays in the stream of the cool air.  Fevers that persist for >24 hours should be addressed by a veterinarian.  Severe fevers over 105F require urgent or emergency care. 

No.  Vaccines will stress the cat’s immune system, which should be avoided if FIP has been diagnosed or is suspected.   

Ideally, surgical procedures should be postponed or avoided, as they will stress the cat’s immune system.  According to Dr Pedersen’s recommendation,  the blanket statement is that he suggests waiting until completing 12 weeks of treatment plus the 3 month window of observation. 

There are exceptions to this rule, based on the unique circumstances of the treating cat. In some cases, the heat cycle may prove to be more stressful on the cat than a minor surgical procedure would be. Provided the lab results indicate that the cat is in good health, consult with your veterinarian about the risks and benefits of spaying/neutering during the course of treatment. 

Prednisolone can be beneficial at the time of diagnosis, and as a supportive drug when beginning GS. Prednisolone acts as an anti-inflammatory, stimulates appetite, and can help the cat feel brighter until the GS starts to kick in. With FIP, prednisolone may help to slow the rate of fluid accumulation until it begins to reabsorb, approximately 10-14 days into GS treatment. 

You can stop the prednisolone once the cat is stable and feeling better with GS. It should be tapered down rather than stopped abruptly.  There should be a very rapid response to the GS in a cat with FIP and no other drugs are needed at that point unless there is a definite indication for it.

If the effusion is in the heart cavity or lungs, the effusion should be drained as much as possible. 

If the effusion is in the abdomen, the fluid should only be drained if it is interfering with the cat’s breathing and then, only enough fluid should be removed to restore the cat’s breathing to normal. 

Input From Dr Pedersen

The FAQs below are compiled from a series of emails between Dr Niels Pedersen and various caregivers who are currently treating with GS441, or who have completed the course of treatment.  

All that we can do at this point is observe what happens over the next several days and hope for the best. If he is developing a sore at the injection site it is possible that this is the cause of the signs we are seeing. If it is sensitive to touch, it is obviously bothering him. If it is a sore, it will either get worse and possibly become an open wound or quickly get better. If it is a sore, and it becomes an open wound, we will help guide you through the treatment. Although we do not wish for severe injection site reactions, this would be a situation where it would be the better choice.

The most dramatic improvement will be in the first week or two and will become slower after that. Do these cycles correspond with when you give the drugs, i.e., is he less active in the few hours after injections and more active as the time from treatment gets longer? We have noticed that some of our earlier field trial cats seemed get a little depressed for a couple of hours after injections. A higher dose will only make it worse. If she is relapsing it will become apparent and if it is just a reaction to the drug we will have to wait it out and see what happens when the treatment is finished.

We are working on changing the diluent for the drug to decrease the stinging and soreness, but that will probably not come to pass for several months and will only address any problem with the diluent and any effect of the drug itself. Applying lidocaine cream to the area after injection is like locking the barn door after the horses get out. We have also tried using it on injection sites before treatment and the owners that have tried it were not happy with the results and stopped using it. 

A published double-blinded and placebo controlled studies of feline interferon omega for FIP showed it to have no therapeutic benefit. I feel the same way about other immune-modulators such as Polyprenyl.

Although theoretically possible, we have not yet seen cats cured of FIP develop the disease at a later date. Therefore, I would concentrate on curing your cat with FIP.

Do not treat the cat that is shedding the enteric coronavirus. This cat is at very low risk for developing FIP, and treating carriers with the enteric coronavirus will only encourage the emergence of drug-resistant strains.

There is no need to worry about giving routine vaccinations at this time. We need to worry first about getting the cat cured. I am also personally not a big fan of FVRCP boosters after the kitten-hood series, the necessity of even vaccinating cats for rabies (unless required by state or local law), or the need to give FeLV vaccines in cats that are at low risk for infection. However, if we can cure the cat of FIP he should be treated according to the standard of care agreed to by the profession, locality (rabies), and your practice policy. In short, treat him like any other normal cat, but let him get cured first.

We do not follow coronavirus antibody titers so I cannot answer your question. However, we would expect it to fall over many months if he were to go into a sustained remission. The fact that it is still high at this early stage does not worry us, but it is perhaps something we should follow if he does not relapse. If he relapses it is somewhat academic. All being said, we are optimistic. His disease signs went into a complete remission and equally important, he gained a lot in weight and stature over the last few weeks. These have been favorable signs with our other cases that suffered non-neurologic disease. The high coronavirus titer also reflects the intense response of his immune system to FIP virus. We would this titer to remain high for a while and then slowly return to a much lower titer. 

We are hopeful that your cat will remain healthy after he stops his treatment, but we must also be prepared if he should relapse. Relapses can occur within 1-84 days, based on our experience with other cats we have treated. The clinical signs of relapse will be obvious in neurologic cases and will basically be a recurrence of the same problems. He will become febrile, stop eating, become less active, and the neurologic signs he had before will return. It is now a matter of documenting what occurs. You can also take his temperature every day for a couple of weeks and then every other day until we reach the 84 day mark. It will be important to monitor his activity level and weight through this period of time.

I prefer the digital rectal thermometers that are fast reading. Also, are you taking the temperature when he is resting and not after a period of exercise? You can see that the temperatures of the two cats are erratic with some being higher at one time than another. The fact that they are both very active and alert and their temperatures are similar does not lead me to be concerned at this point. Let us stay calm and see what happens. However, we realize how difficult this waiting period can be.

Cats and other small animals are not nearly as consistent in their systemic temps as humans and the fluctuations you see are not uncommon. The problem is that the more worried you are, the more temps you will take, and the more of these fluctuations you will see. Therefore, we worry less about these sort of fluctuations and much more worried when temps are consistently 103 and above. Most importantly, we always look at the entire picture and appetite, activity levels, and clinical signs are even more important. In short, fluctuations like this are OK as long as they do not become constant and are associated with a loss of appetite and activity. If your cat is otherwise ok, and given that there is no evidence yet of a sustained fever, I would recommend that we keep her at home where she can be freed from unnecessary stress and closely watched. A visit to the veterinarian may calm nerves, but it may also make the nerves worse. 

The lymphocyte count is just a bit higher than normal, but this is actually good. A low lymphocyte count would indicate that the infection is active and severe, while high indicates that he is mounting an immune response.

No worry about kidney function as the BUN and Creatinine are within the normal range. We disregard the high phosphorous. Even if these were high, a urineanalysis would not tell us anything at this point. We can revisit these values in a month.

Yes, there is evidence of kidney damage and given the recent change and the fact that your cat is on this treatment, my guess is that your cat may have sustained some moderate kidney damage. We have only observed kidney damage, which was milder than this, in one of over 30 cats we treated for 12-36 weeks in total and even at higher dosages than what you used. However, this type of drug is known to cause kidney toxicity in some humans treated for HIV/AIDS or hepatitis C. This damage is reversible if you stop treatment soon enough, and I assume that you have already stopped treatment. If not, and you are at or near the end of the 12 weeks, stop it now. It will not reduce the chance of a cure. Make sure that your cat has ready access to water, and if his appetite is affected, feed him wet food that he loves with water added. Cats love wet food with gravy and this is where you can mix in a little extra water. There are commercial and home made diets for cats with kidney disease, but they are not very palatable and they do not treat kidney disease but rather help reduce the stress on the remaining healthy kidney tissue. I would also make sure that your veterinarian does a urinalysis to see how low the specific gravity has gone – the lower it is the more kidney damage. Also, the more water they consume and urine they produce, the more damage. You will also want to look at the urine for any sign of bacterial infection either in the urine sediment or by culture – if found, he should be immediately put on antibiotics. 

Yes, at least one enterprising person in China has made an oral form of GS-441524 that she claims will work as well as the injectable formulation. This is not surprising, as the modifications required to make injectable drugs into an oral form are well known. All the drugs for HIV/AIDS and hepatitis C have been converted to oral forms. However, you may find, as do many others, that it is harder to pill cats than to give them injections. They will usually adjust to the shots over a short period, but if they object to pilling, it will only get worse and not better. Therefore, if you go this route, do not invest heavily in it until you are sure that it is going to work for your cat. 

I know nothing about the oral form of GS. Therefore, it is impossible for me to provide any reliable help. However, there must be a reason why this Chinese maker is telling people to give it twice a day and not once a day. Perhaps it is because giving it all at once is upsetting to their system. It does not make sense that the drug is cleared from the bloodstream faster when given by mouth, which is another possible reason why they want to split the dose. It is significant to me that these people are heavily pushing the oral drug but have not provided any preliminary data on how it behaves in normal cats and in preliminary field studies on cats with FIP. 

You should not mix the two medications on a daily basis. However, there is no problem in changing from one form of medication to the other, as you are suggesting. The diluted drug that they supply usually contains 15-16.5 mg per ml and the dosage for your cat is 4 mg/kg, SC, once a day or around 14 mg (1.1 ml) once a day. Therefore, the dosage they gave you is correct, but will need to be increased as he gains weight.

First, GS-441524 is extremely stable in a highly acidic diluent, such as is being used by these suppliers. We have kept it for months in a refrigerator. More likely reasons for relapses include insufficient treatment (poor injections, poor quality drug), inability to get sufficient drug levels into lesions (such as the brain), or drug resistance (We saw it in 1 cat in both our GC376 and GS-441524 trials).

You should not mix the two medications on a daily basis. However, there is no problem in changing from one form of medication to the other, as you are suggesting. The diluted drug that they supply usually contains 15-16.5 mg per ml and the dosage for your cat is 4 mg/kg, SC, once a day or around 14 mg (1.1 ml) once a day. Therefore, the dosage they gave you is correct, but will need to be increased as he gains weight.

This virus is so ubiquitous, hard to eliminate, and so easy to have re-infect, that I have argued that attempting to eliminate it will be a highly expensive and largely unproductive undertaking. Although it is possible to eliminate FECV from a small group of cats that are kept in strict isolation and using fecal testing, in reality, this is much easier said than done. Finally, even if you do get rid of it from your cats, with tremendous effort and expense, what are you going to do then?! The only way to keep it out is to maintain an extremely strict quarantine of cats and people moving in and out of your premises, which largely defeats the ability to maintain a functional shelter, rescue or cattery.

The AGP test is popular in Europe, but I cannot figure out why it is so. The test measures what we call a “phase reactant” and is a measure of inflammation in the body. It is totally non-specific and adds hardly anything to routine measurements such as overall appearance of health, loss of body weight, fever, abnormalities in white cell parameters in a CBC, albumin and globulin levels, A:G ratio, etc.

Dedicated to all FIP angels.

All information contained on this website is compiled from real-life experiences of cat owners who are currently, or have previously treated their cats for FIP.  Most of us are not veterinarians and the  information provided within is not intended to substitute or replace medical care by a licensed veterinarian. 

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