QUARTERLY BEAT
JULY 2026
Update #4: Expect Early Improvements; Otherwise, Consider Changing the Plan!
Update #7: When can FIP Cats get Back to Routine Veterinary Care? • Spay/neuter: Ideally, wait >1 month after finishing antivirals. If surgery has to happen during treatment (life happens!), it’s likely OK - just continue antivirals 2–4 weeks post-op to keep treatment momentum on your side. • Parasite prevention: Deworming and flea/tick meds can continue during treatment - no need to pause the basics. • Vaccines: We still need prospective data, but current thinking is: if the cat is clinically well, killed/non-live vaccines are probably reasonable during antiviral therapy. Live vaccines, are still a question mark, so it’s recommended to save those for >1 month after treatment ends. Do cats with FIP relapse after treatment? The first month after stopping antivirals is the prime relapse-risk window. Thankfully, relapse is uncommon (often quoted at <10%) and becomes rare once a cat cruises past the 4-week mark. That said, prep cat owners that relapses can happen, and they don’t always look like the cat’s original FIP presentation. Some cats throw new curveballs, including new neurologic, ocular, or even gastrointestinal signs despite originally presenting with effusion. That’s why a recheck exam around 4 weeks off meds is typically recommended. And if you have it, a normal post-treatment AGP is a nice little confidence boost that things are really staying on track. Conclusion When in doubt, for the newly diagnosed cat with FIP the gameplan should be: start treatment early, dose according to the cat’s clinical signs, and know when to tweak the plan/ Build in early check-ins so you can pivot fast if the cat isn’t responding quickly to treatment. As our knowledge (and collective clinical experience) with FIP therapy grows, expect these recommendations to evolve right along with it. And the best update of all? We’re no longer asking whether to treat FIP - we’re fine-tuning how to treat it. That’s a pretty fantastic problem to have…because it means more cats are surviving long enough for us to fine-tune the details.
Coach owners to be your at-home “FIP vital signs team”: track resting respiratory rate/effort, appetite, and overall behavior. Cats should start looking better quickly, so if they’re not trending upward, or if cat owners observe faster/labored breathing, inappetence, erythematous/painful eyes, or new/worsening neurologic signs (e.g., depression, ataxia, seizures), the cat should be evaluated ASAP for a possible dose adjustment. Before calling the failed response a “drug failure”, start with the basics: confirm the medication is actually getting into the cat and being given on schedule, because “I gave it” doesn’t always mean the cat got it! Also remember that in the first 48 hours (while drug levels are building) it’s possible to see worsening or new onset of clinical signs. Update #5: Therapeutic Drug Monitoring (TDM) is Entering the Chat (in Some Regions) TDM isn’t mainstream (yet), but it’s likely where we’re headed. More personalized dosing - especially for cats who aren’t improving on schedule - may eventually let us fine-tune therapy for the tricky cats, especially those with questionable GI absorption (hello, IBD cats!)..
Update #6: For Adjunct Drugs, ‘Less’ is Often ‘More’
Corticosteroids: Try to avoid, but don’t shy away if they’re needed! Yes, FIP cats can come with comorbidities that may benefit from steroids (e.g., IMHA, IBD). For uveitis, a short course of topical corticosteroids is reasonable for comfort during the first 1–2 weeks of FIP treatment. If clinical signs still require corticosteroids beyond 2 weeks, that’s more suggestive of undertreated FIP, so the antiviral dose may need a bump. Immune-mediated hemolytic anemia has been rarely reported along with FIP, and the good news is we have weak evidence suggesting 0.5-2 mg/ kg/day prednisolone does not negatively impact survival. So if you needsteroids for a true immune-mediated problem, or to dampen inflammation, they’re not automatically off-limits!
ABBREVIATIONS: • A:G: albumin-to-globulin ratio • AGP: alpha1-acid glycoprotein • ALT: alanine aminotransferase
Immunostimulants: As tempting as these may sound, the evidence isn’t quite there (yet). Current guidelines don’t recommend routine immunostimulant use with FIP, largely because we’re already seeing excellent response rates with antiviral therapy alone. So for most cats, this is one more add-on we can skip.
• CSF: cerebrospinal fluid • FCoV: feline coronavirus • FIP: feline infectious peritonitis • IBD: irritable bowel disease • IMHA: immune-mediated hemolytic anemia
• RNA: ribonucleic acid • SAA: serum amyloid-A • TDM: therapeutic drug monitoring
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