Treatment of equine sarcoid with the mistletoe extract ISCADOR(R) P (viscum album austriacus) : a double-blind placebo controlled study

Background: The Equine Sarcoid (ES) is the most common skin tumour in horses. It is difficult to treat: recurrence rate is high and no single universally effective treatment for ES is known. Viscum album extracts (VAE) are used as adjunct in the treatment of some human cancers without known side effects. Hypothesis: We hypothesized that the long-term therapy with VAE (Iscador® P) is effective in Equine Sarcoids as a single treatment or as an adjunct treatment to selective surgical excision. Material and methods: Of 53 horses with ES, 42 were treated solely with VAE as monotherapy and 11 were treated after selective excision of ES. Horses were randomly assigned to the treatment group (VAE; n=32) or control group (Placebo; n=21). The horses received rising concentrations of Iscador® P extract from 0.1 mg per ml to 20 mg per ml or physiological NaCl solution 3 times a week over 105 days s.c. Number, localization, size and type of the ES were documented over 12 months. Horses were grouped in 3 classes: individuals with 9ES. Statistical analysis of effects was divided in horse level and sarcoid level analysis. In horse level analysis effects were assessed considering the development of all 3 tumours found in the horse. Outcome of this analysis was cure, improvement (decrease of tumour size by 50% or more in at least half of the tumours), unchanged status or deterioration, respectively. Sarcoid level assessment included analysis of 1 to 7 clinically relevant sarcoids per horse comparing parameters of size and quality of single tumours in both treatment groups. All analyses were performed using statistical package STATA ver.9.2. Significance level was set at p<0.05. Results: Horse level: In the VAE group, 13 horses (40.6%) showed an improvement. Of these, 9 patients showed complete remission (28.1%). In the control group only 3 cases (14%), all showing complete remission, were classified as improved. Significantly better results were observed after VAE treatment in horses with 3 to 9 ES compared to those with 9 ES. Sarcoid level: After one year observation time in the VAE group 27 ES showed complete remission (37.5%) and there was an improvement in 48 (66.7%) ES. In contrast, in the control group 9 ES with complete remission (13.2%; n.s.) and 17 ES (39.5%; p=0.005) with improvement were found. The only side effects observed after VAE were slight oedema at the injection site in 5 of 32 cases, which disappeared spontaneously within two to three days. Conclusions: VAE (Iscador® P) represent a safe and effective treatment for ES, particularly in cases with multiple sarcoids

Misteltherapie bei Hauttumoren der Tiere

Die Mistel, diese mythische Pflanze, die Druiden mit ihren goldenen Sicheln geerntet haben, wird noch heute gegen Krebs in der Humanmedizin verwendet. Seit 20 Jahren, werden die Mistelextrakte auch in der tiermedizinischen Tumorbehandlung eingesetzt

Behandlung des Equinen Sarkoids mit einem Mistelpräparat

Das Equine Sarkoid (ES) ist eine weit verbreitete Erkrankung, die in der Schweiz mehr als 10% der 3-jährigen Pferdepopulation betrifft. Auch in Österreich kommt dieser semimaligne Hauttumor häufig bei Pferd und Esel vor. Obwohl das ES keine lebensbedrohliche Krankheit darstellt, wird es je nach Lokalisation vom Besitzer oft als unästhetisch empfunden

Using Viscum album extracts (ISCADOR) for successful management of neoplasms of the skin in horses and cats in consideration of aspects relevant to human medicine.

Background: Mistletoe extracts (Viscum album extracts, VAE) such as ISCADOR, have been used successfully in human oncology for many years. In veterinary medicine, there have been reports of successful treatment, but scientific data on efficacy are lacking. Two studies were therefore conducted to assess whether VAE can serve as an adjunct to standard treatment in horses and cats. Methods: As part of a placebo-controlled double-blind study (study 1), 53 horses with equine sarcoid (a solitary or multifocal skin tumor) were treated with VAE pini (pine mistletoe) in progressively increasing doses (n=32) or with a sodium chloride solution (n=21). Three times a week for 15 weeks. All horses were observed over a period of 12 months for tumor recurrence and cure. In an observational study (study 2), 44 cats with fibrosarcoma, a very common skin tumor with a high rate of recurrence, were treated postoperatively with 0.1% (0.5ml per dose) oral VAE quercus (oak mistletoe) twice daily, and disease free survival was measured. Results: In study 1, treatment with ISCADOR led to significantly better results than placebo. Improvement was seen in 41% of the cases (placebo 14%), and cure was achieved in 28% of the cases (placebo 14%). In study 2, disease-free survival time in cats treated postoperatively with VAE quercus was 438 days compared with 365 to 475 days for conventional chemotherapies and 120 to 261 days for surgery alone, as seen in literature. Aggressive surgery combined with radiation and chemotherapy led to markedly superior results (661 to 986 days). Conclusion: The study 1 was able to demonstrate, for the first time, the efficacy of VAE compared to placebo control. This study also showed that the effect of VAE apparently extends considerably beyond the treatment period; unexpectedly, only very few recurrences were observed between the end of treatment and the 12th month of observation. The results of the study 2 show that oral administration of mistletoe preparations also yields satisfactory prophylactic effects. The discussion surrounding oral treatment and the question whether it can replace injection treatment must therefore be continued, even in human medicine

Safety and Efficacy of Mistletoe extract (Viscum album) Iscador(R) P in Equine Sarcoid

Equine Sarcoid (ES), a semi malignant skin tumour, is the most common neoplasia of horses (Marti et al.1993). There is no generally effective single treatment existing and the recurrence rate is high (Martens et al.2001). Furthermore as a treatment obstacle, Sarcoids tend to occur as multi-focal tumours or can be found in critical locations (peri-ocular) where success of surgical interventions is very limited (Carstanjen et al.1997). Due to encouraging results in human medicine and small animals practice after adjuvant cancer treatment by mistletoe extracts (Biegel et al.2007) the viscum therapy could hypothetically fill a therapy gap for equine tumour diseases as well. Hence, goal of this clinical trial was to evaluate the safety and efficacy of Viscum album pini (Iscador® P) as a primary therapy of Equine Sarcoid in the context of a prospective, randomized, controlled, double-blind study. Material and Methods: 53 horses with histologically confirmed diagnosis Equine Sarcoid were randomly assigned as Iscador (I; n=32) or Control group (C; n=21). There are 23 mares, 25 geldings and 5 stallions ranged in age from 3 to 17 years with an average of 7.2 years. The horses received scalating dosages of Iscador® P starting at 0.1mg up to 20 mg extract per 1 ml dose or physiological NaCl solution 3 times a week over 105 days sub-cutanously into the pectoral region. The number, localization and morphology of the ES were observed and documented over 12 months. As target variable the positive outcome rate (PO rate) was calculated representing the patients status at the end of the investigation. Results: In the Iscador Group 13 horses (41%) showed an improvement (at least 50% tumour remission). Of these cases a number of 9 patients showed complete cure (28%). In the Control Group only 3 cases (14%; all with complete cure) were classified as improved (p<0.05). Discussion & Conclusions: Iscador® P extract (viscum album pini) represents a safe and efficient therapy alternative in Equine Sarcoids, particularly in cases of multi-focal character. In tumours grown in problematic localizations a therapy attempt with viscum album extracts should be conducted to avoid the risk of damage the intact surrounding tissue, particularly in the eye area. Iscador® P shows significantly better outcomes (cure and improvement) compared to placebo control. Younger horses and horses with more than 2 tumours are responding with higher PO rates than older patients and horses with 1 to 2 ES. This fact could support the control of multiple sarcoids which can be excised only by immense surgery expense. Further investigations to understand factors of response and non-.response have to be conducted in the future. Additionally, due to the good tolerance by the patients and the acceptance of long-term protocol the practicability of Iscador ® P therapy can be assumed. Younger horses responded more often with a positive outcome (PO) than older (Fig. 2a) with PO rates of 57%, 40% and 13% for horses being less than 5 years, 5 to 9 years and more than 9 years, respectively compared to PO 25%, 10% and 0% in control. A significant better therapy course appeared in the Iscador group for horses with >2 ES (Fig. 2b): a number of 12 of 25 horses (48%) showed an improvement, 9 of these a complete remission (36%) including ES localized at the critical areas (head and around the eyes) compared to 6% in the control group. Iscador® P extract (viscum album pini) represents a safe and efficient therapy alternative in Equine Sarcoids, particularly in cases of multi-focal character. In tumours grown in problematic localizations a therapy attempt with viscum album extracts should be conducted to avoid the risk of damage the intact surrounding tissue, particularly in the eye area. Iscador® P shows significantly better outcomes (cure and improvement) compared to placebo control. Younger horses and horses with more than 2 tumours are responding with higher PO rates than older patients and horses with 1 to 2 ES. This fact could support the control of multiple sarcoids which can be excised only by immense surgery expense. Further investigations to understand factors of response and non-.response have to be conducted in the future. Additionally, due to the good tolerance by the patients and the acceptance of long-term protocol the practicability of Iscador ® P therapy can be assumed

Entwurmung von Pferden - Strategiewechsel von "viel hilft viel" zu "so viel wie nötig, so wenig wie möglich"

Die meisten Islandpferde geniessen regelmässigen Weidegang. Neben vielen positiven Effekten auf Gesundheit und Wohlbefinden besteht auf der Weide auch das hohe Risiko einer Ansteckung mit Wurmparasiten. Je nach Wurmart und Befallsstärke können diese die Gesundheit der Pferde gefährden. Früher war deshalb die routinemässige Entwurmung aller Pferde zu drei bis vier bestimmten Zeitpunkten pro Jahr üblich. Heute ist aber aus diversen Gründen ein Parasitenmanagement angezeigt, welches auf regelmässigen Kotanalysen und selektiver Behandlung beruht