Good evening everybody, and welcome to tonight's webinar. My name is Bruce Stevenson, and I have the honour and privilege of chairing tonight's webinar. Before we get started, I just want to say a huge big thank you to our sponsors, Domes Farmer.
Thanks to their generous sponsorship, we are able to bring you this webinar tonight, with these exciting new products that you're going to hear about tonight. So a big thank you to Dome's farmer. Little bit of housekeeping as well.
For those of you that haven't been with us before, if you have any questions, just move your mouse over the screen. You'll see that there's a bar that pops up. It's usually a black bar at the bottom.
There's a little Q&A box there. Just click on that, type your questions in there, and they will come through to me, and we will hold those over, to the end of the meeting. We will not be answering them in amongst the presentation.
And we'll get through as many of those as we can at the end. So, it is my privilege tonight to introduce our two presenters, Doctor Emma Hancock, who graduated from Bristol Vet School in 2016 and worked in first opinion practise before joining Dome's Pharma in 2022 to pursue her interest in ophthalmology and neurology. Our other presenter is Doctor Catherine Lovegrove, who graduated from the University of Veterinary Medicine in Budapest and worked as a small animal vet in first-in practise.
She joined Dome's Farmer in 2023 as a veterinary advisor. Ladies, welcome to the webinar vet, and it's over to you. Thank you, Bruce, thank you for that introduction.
And thank you all for joining us this evening as well, and for those watching on demand perhaps too. So I'm Emma and I'm joined by Catherine, and we are both technical vets at Domes Farmer. And we're here to introduce you to our two new products in our anxiety range, Tessie and Boncat.
Some of you may know that the products have been available for a few years now in Scandinavia and other European countries, and that they've been registered for some time in the UK actually. And there's been quite a lot of excitement about these products, and we are pleased to say that the wait is finally over, with these products being available in the UK since November. So what we are going to talk about tonight, this presentation will be a bit of a tale of two halves.
I'll give a brief introduction to situational anxiety, and then I'll focus mainly on dogs, where we'll go through some statistics and look at the role of the GP vet in behaviour cases and introduce you to Tessie. And then I'll hand over to Catherine to talk about acute anxiety in cats, a reminder on a cat friendly approach, and of course to introduce bocat. We will then finish up with answering a few of our most frequently asked questions that we get on our tech lines and pointing out some useful resources and contacts.
And hopefully we will get time for some few more questions at the end. So without further ado, let's get going. So tonight we'll be focusing mostly on situational anxiety in dogs and cats, which is a catch-all term for anxiety, fear, or distress in response to a certain trigger or an event.
And this is opposed to generalised anxiety, where there is no obvious trigger. Some of these most common triggers include noise, separation, they're probably the two biggies. And we used the term separation anxiety, but now we know that the term separation related problems is much more appropriate.
And of course, closer to home for us is is veterinary visits, of course, and transport or travel. And when it comes to the management of these, generally we need some sort of behaviour modification, so training or teaching our pets that actually these situations are not to be feared. But also behaviour modification perhaps of our owners.
Are they accidentally reinforcing the behaviours? Are they in fact punishing the behaviours? And do they allow their pet's time to get used to the car or the carrier, for instance?
And also of ourselves as veterinary professionals. Are we employing cat and dog friendly techniques to reduce our patients' anxieties as much as possible? But we do know there is a subset of patients that will require medication as and when to help them cope with these situations.
And hopefully we can show you where our two new products can fit into that. So let's start with dogs. We'll start off by looking at some statistics and just painting a picture of what the current situation looks like in the UK at the moment.
And apologies for our international viewers, this is very UK specific. So did you know that 13% of dogs are reported to show signs of distress when left alone? And I wonder whether the audience thinks this is lower or higher than perhaps you would have expected.
I think most people would probably actually say lower, and I too was surprised by this statistic. I thought it would probably be higher than this. But the crux here is the term reported to show, and behavioural problems can be largely underreported by pet owners.
Conversely, up to 50% of dogs show physical behavioural signs of fear when they're exposed to loud noises. However, when you ask the same cohort of owners, is your dog fearful, only 29% consider or even realise that their pet is actually scared. And therefore there's a large discrepancy between what the dogs are trying to tell us and what the owners are perceiving.
And this can be explained by the fact that 88% of dog owners actually failed to identify these early signs of distress in their dogs. And this is of course a massive welfare concern. If we translate those previous statistics to the UK dog population, that means that actually up to 1.4 million dogs are experiencing separation related problems, and around 5.4 million are affected by fear of loud noises.
But of course, given what we mentioned, these numbers are likely to be actually a lot higher than this. And I wonder if anyone could hazard a guess as to what this number relates to. What is about a quarter of a million.
So this is actually the average UK search volumes for the term dog anxiety per month. So every month, around a quarter of a million UK dog owners are searching dog anxiety online. So even though they may not be able to recognise those early signs, we know that this is an area that worries many pet owners.
So what is the implications of this? Well, we know that if behavioural problems are not addressed early, then they tend to progress. That is every time the dog is exposed to a situation in which it's fearful.
Learning occurs, and it's really unlikely that the signs will get better over time. In fact, more often than not, the signs worsen over time. Added to that, behavioural problems often generalise.
So we have an overall increase in the frequency in which these signs are exhibited. But also the dog may exhibit signs in a wider array of situations. For example, if we consider a dog with separation related problems, this may have started as a dog who is only anxious when left completely alone.
But it may start to become anxious when their main caregiver leaves, even if there's someone else in the house. And we all know of cases where dogs can't even be left in one room alone and often follow their owners, even to the bathroom. And we also know that often behavioural issues can associate with each other.
And one study demonstrated that the probability that a dog with noise sensitivity also has separation related problems was 88%, which is huge. And of course these have massive welfare implications for the dog, but they also have implications for the owner. The pet owner bond becomes strained and can eventually lead to even more extreme measures like relinquishment or even euthanasia if the owner cannot cope with these behaviours.
Statistics, we know the signs of distress can go unrecognised by owners, but we also know that early intervention is key to successful outcomes. So it's really important that our owners can recognise this distress in their pets. Dogs may display a wide range of signs, not all of which necessarily present every time and which may be exhibited with differing intensities or frequencies.
But here are some of the most common signs associated with distress. Some of these signs are of course more obvious, and clients are often more inclined to report these. So for example, elimination, destructive behaviours, and persistent vocalisation, especially if they've been told off by a neighbour.
But not so often do they recognise the more subtle clinical signs, such as yawning or lip licking or salivation, or pacing. And particularly when it comes to separation problems, some signs are exhibited only after the owner has left. But many of the triggers for separation occur well before this.
For example, changes on our routine before we leave, packing our bags, getting our keys, and these are crucial times that owners can start to pick up on any of these maybe more subtle clues. So it's really important to educate owners, and everyone in the vet team can have a role in this. So front of house staff are often the first point of call and owners can feel a lot more confident speaking to these or vet nurses over us vets.
So to aid this, we have board kits and posters available for waiting rooms with an associated short questionnaire with a simple tick box of signs. And this questionnaire can then be flagged to the vets or nurses should a problem be noted. And hopefully together we can start tackling these problems a lot earlier.
And this brings us into the role of the GP vet. I mean, I know as a GP vet myself that behaviour consults can be quite overwhelming, and perhaps I felt a bit out of my depth for giving behaviour advice and maybe I wasn't even sure where to start or how much information I should be giving to the owners. So what we want to hopefully do over the next few slides is provide our GP vets watching with some guidance as to how to approach behavioural signs in practise.
And firstly, whenever we talk about behaviour, we need to remember that behaviour is simply an output. And it could be impacted by a variety of inputs. So there could be a physical health problem, they could have an emotional basis to them, or even a cognitive issue.
And cognition is the ability to learn and to make decisions. So if we have a look at a couple of examples. An owner perhaps might come into the consult room and say that their dog has started urinating in the house.
Now this could have a physical health problem underlying this, so for example, a urinary tract infection. It could actually have an emotional basis, so perhaps this dog has experienced panic when it's left alone and has urinated in the house. Or is this actually an older patient who has cognitive dysfunction and has started to lose its toilet training abilities?
If we look at another example, and I don't want to use the term aggression, but our owners sometimes do, if they come in to say, you know, their dog has bitten or snapped at somebody. Actually that might indicate a physical health issue, so has it been painful where they've tried to touch them, or is the dog guarding where it's painful? Is this actually a fearful patient and those warning signs were perhaps missed?
Or has this patient not learned bite control? And so it's really the role of the GP vet to understand these, explore these likely causes, and to advise the clients appropriately. But the Heath model of emotion also reminds us that these three factors are inextricably linked and also impact on each other.
For example, if we take a look at a dog with pruritus, the dog probably does have a physical health issue underlying this behavioural sign, for example, fleas or allergic skin problems, for instance. But the constant need to scratch will also result in frustration, and it's probably very uncomfortable, and this will impact on the dog's quantity and quality of sleep. And then this will impact on the dog's cognition and its ability to make decisions.
We know a frustrated patient is more likely to engage in conflict behaviours, and therefore this patient might even be described as being snappy. But that's probably because it's tired and frustrated. And this, this might impact on its ability to learn if we're trying to train them, for example, if we've got a puppy with fleas or parasites, etc.
And although these definitions aren't currently set in stone, it's important to remember that there is a difference between behavioural medicine and behavioural counselling. So behavioural medicine is the branch of medicine that identifies these problem behaviours as just another clinical sign or symptom, indicating that that pet's welfare or its medical needs are not being fully met. And this is primarily to understand and to diagnose if there's a physical or a mental health issue contributing to these signs and to discuss the possible medical options for this.
And in the human world, this would equate to our general practitioner or a doctor. And once any physical health issues have been addressed, behavioural counselling, therefore, is the process of identifying the root cause and the implementation of behavioural modification programmes with the aim of changing the unhealthy or unwanted behaviours for the long term. And in the human world, this is often our therapist or our counsellor.
And it's highly unusual that your GP would be both, that your GP would also be your therapist or counsellor, and rather they would refer you to an appropriate clinician. And so it's also true that offering a full behaviour counselling service can be beyond the capacity of many veterinary practises. I mean, if you are equipped and you have the vets and nurses that are able to provide this service, then that's brilliant.
But if not, it would be worth discussing with your teams who would be your referral behavioural clinician, and we can show you towards the end some reputable sources if you don't already have one. Third, for most of us, focusing on behavioural medicine and treating behavioural signs as we would any other clinical sign and understanding if there's a physical health problem to underlying these is often the most appropriate place to start. And therefore, as with any clinical sign, a full history and a clinical exam is really important.
So considering the signalment, we mentioned it before, is this an older patient who might have a away or cognitive decline, for instance? What is the problem or symptoms and when did they first start? Did, for example, it start at bonfire night or did it start alongside any other signs or symptoms, for example, did the patient vomit and now they're off their food?
And are the problems situational or generalised? Like are there, are there any triggers for these behaviours? And this will likely help us to understand how severe the problem is and what type and and level of intervention that might be needed.
And of course performing a clinical examination to include a full physical and a neurological examination, but also a pain or orthopaedic examination is a must. And of course any further testing as appropriate, so blood sampling, urinalysis, radiography, etc. And we might also need to do more specialised tests or tests in different environments based on the observed clinical signs.
So for example, an animal that shows fear of stairs or certain types of flooring might have a musculoskeletal problem causing difficulty or pain in movement, but that might not be apparent on a level grippy consult room surface. And then from there of course we can treat any findings appropriately. But it can also be really useful to conduct a pain relief trial.
In one study of 100 cases that were presented to referral veterinary behaviourists, pain was identified as a cause for or influence on the behaviour in 2028 to 82% of cases, which is massive. And then of course, in order to protect our patients' welfare, we should consider using behaviour modifying medications. Unfortunately, I think there is still a bit of a taboo or perhaps a reluctance to start behaviour modifying drugs.
And perhaps this is slowly changing. But for example, we would never consider withholding analgesia from a painful patient. And therefore, why should we withhold aniolytics from an anxious patient?
And we can always utilise these as we're investigating or arranging ongoing behavioural support where appropriate. When we consider the management of separation related issues, of course, behavioural counselling and training would always be recommended, but I will definitely leave that to the experts. However, when we consider the products that are available to help with this, there are generally two main areas.
So we have the over the counter over the counter products, sorry, and these include the calming supplements, things like pheromone or essential oil plug-ins or sprays. And whilst of course they have their place, owners have often already utilised a lot of these measures before seeking veterinary advice. And then when it comes to medications, the licence, the licence options are, are currently limited to long term daily medications.
And this can be a barrier to treatment, as you can see that there is quite a jump between these two categories for owners. And this does leave a bit of a gap in the middle of these categories. And that's exactly where we can see Tessie fitting.
So Tessie is the first fast acting licence solution for separation issues. But it does get better than that because it does have a dual purpose in its indication. So it's indicated for dogs, for the alleviation of situational anxiety triggered by noise as well as owner departure, hence that dual purpose.
Tessie contains a completely novel active ingredient, taccipiidine, which is an alpha 2 agonist. It's presented as an oral solution with a dose of 1 mL per 10 kg. And because this is a 15 mL bottle, there are 15 doses for a 10 kg dog.
Because it's a multi-use bottle, Tessie also has a long open shelf life of 12 months. Now testsie should be refrigerated, but we do have some flexibility in its storage. It can be kept at room temperature for up to one month within that time, which is particularly beneficial for those situations where the owners have forgotten to put it back into the fridge, for instance, or if they need to transport the bottle to a dog sitter, for example.
And when we say fast acting, well, how fast is fast? So Tesi takes effect anywhere between 30 and 90 minutes with an average of 60 minutes. And Tessie is an anxiolytic.
It's not a tranquillizer nor a sedative, so the dog should remain calm but fully functional. As I mentioned, Tessie has an onset of action within 1 hour and is expected to last 3 or more hours. But it can be redosed if needed, up to a maximum of 3 doses in 24 hours.
And this makes Tessie the first licenced use as and when medication to aid with separation related problems. And if we consider the owner demographics, we've seen a real shift in the working habits, especially since COVID, with more people working from home, part-time working or hybrid working. And as we've mentioned, one of the barriers to treatment of separation related problems is that owners don't want to put their pets on to long-term medications if it's only needed a couple of times a week or every so often.
So as well as making life less stressful for the dog and the owner, Tessie as a short-acting use as and when medication can really complement that new modern working lifestyle. Do this. So we know stress, fear and anxiety are mediated through an area of the brain called the locus eruleus.
And when exposed to a stressor or a trigger, for example, a loud noise or signs of impending separation, for instance, there is an increase in the neurotransmitter noradrenaline being released from the locus Aurelius. We know noradrenaline is one of our main neurotransmitters involved in our fight or flight response and is highly involved in a pet's panic response to these situations. But not only that, but the locus erulus has connections or projections to many other parts of the brain and body, physically preparing the body for action, for example, increasing heart rate and blood pressure.
But also enabling us to learn from these stressful situations. For example, how to avoid them, and what worked well or didn't work so well the last time we encountered this particular stressor. And this in part explains why behaviours can progress over time.
So taccipiidine binds to pre-synaptic alpha 2A adrenosepis within the locus Aurelius and inhibits the release of noradrenaline. Therefore, this fight or flight response is now our rest and digest response and we reduce the panic, fear and anxiety the animal perceives and experiences. Importantly, taccipimidine does not possess amnesia properties, that is, it doesn't block memory formation.
So we can use it to support the pets learning that these situations are not to be feared. Add to the clinical trials, so more than 400 dogs have taken part in clinical studies with timidine, and these were randomised double blinded, placebo controlled trials, which of course we know are one of the highest levels of efficacy we can have, or sorry, we can have. And added to this, Tessie has a good safety profile.
There are no serious adverse events. The most common were lethargy and amesis, although lethargy could be misinterpreted as a calm dog that's happy to sleep, whereas before it wouldn't have. And in the data sheet for Tessie, a test dose is advised if the dog is to be left alone.
And remember this, we'll come back to it towards the end. And when it comes to potential patients for Tessie, we know there is a spectrum of dogs from those that are milder or exhibit behaviours more infrequently all the way to those that are more severe. And as mentioned before, we know that behavioural issues, if left unchecked can progress and generalise.
And because of the lack of options and those barriers to treatment that we've discussed, it's often not until dogs are severe that they often start receiving medical treatment. At which point we're having to start backpedalling down the spectrum, and that's really difficult to do. So hopefully with Tessie and that flexible option of it that it provides, we can intervene much earlier and hopefully stop that progression.
However, we know that there will be a subset of dogs that are severe and may already be on these long-term medications. And so Tessie has been studied in combination with clomipramine and fluoxetine, for example, if they require a top up or an additional medication at certain times. So that was very much a whistle stop tour of Tessie, licenced for the fast alleviation of noise and separation related problems, in an easy to administer oral solution where the dog remains calm but fully functional, hopefully enabling that early treatment and complementing the modern working lifestyle.
At this point I will hand over to Catherine, who will talk about cats. Thanks Emma, hello everyone. So this next 20 minutes will be all about cats, and I couldn't do a webinar on cats without first introducing my own cat, Peggy.
So here's Peggy in all her glory, taking up half your screen, which is more than appropriate. I will start with some statistics to paint a picture of the current situation, the current problem in the UK. So did you know that 39% of cats are not receiving routine health checks annually?
This leaves cats vulnerable to disease and it prevents early disease recognition and intervention. Over half of owners, so 58% said that they don't visit the vet as often as they would like. And we know that deferring vet visits could be detrimental to the cat's well-being, and cats are likely to be more seriously ill before veterinary care is sought.
And of course combined with that previous statistic, this is clearly a welfare concern. Last but not least, one of the main barriers to cats receiving veterinary care is stress. So just over a quarter of owners, 26%, say they don't visit the vet due to stress.
So it's stressful for the cat, but it's also stressful for owners too. And owners witnessing stress in their cat is likely to be an important factor when deciding whether to bring their cat to the vets or not. So if we translate those previous statistics to UK populations, this is what the picture looks like.
So there are approximately 11 million cats in the UK. And over 4 million are not receiving regular veterinary care, with 1 million missing out on vet care due to stress. I wonder if anyone has an idea of what this number is in relation to.
There's 47,900. Actually relates to the number of times that cat stressed has been searched every month in the UK, so 47,900 times per month. And a proportion of this may be me researching for this webinar, but I think this clearly highlights that stress in cats is a significant problem and a concern among cat owners.
And that it potentially also shows that clients are looking for information from Doctor Google rather than searching good reputable advice from their vet professional. So anxiety and fear related behaviour is one of the main reasons for not taking a cat to the vet. And whilst this, these reasons for this are obvious to us, it may not be so obvious to our clients.
This next video demonstrates what a typical journey to the vets may look like from a cat's perspective. And while you watch this video, have a think about the possible stressors that the cat could be exposed to. I, I'm sure we can all agree there are many possible stresses here, physical confinement, my hands reaching into the carrier, an unstable carrier, unfamiliar sounds, sights, smells, that lack of sense of control.
And this also highlights that the veterinary visit really does begin at home. A cat is likely to be exposed to a number of stressors, which gives us this concept of stressor stacking. Of course, the cat's journey doesn't end after transportation.
The cat will be exposed to a number of other stressors in the waiting room, during the consultation, hospitalisation, and don't forget the journey back home again too. How a cat copes when exposed to these these stresses will depend on a number of factors. And this includes the cumulative exposure to stresses and the duration of that exposure.
But also cats with compromised physical health, and we know that pain can exacerbate emotions or fear anxiety. Coping ability will also depend on the cat's individual temperament as well as any previous experiences and prior learning. And we know that cats have long-term memory and learn from both positive and negative experiences.
Is a protective emotion to a perceived threat, and the goal of the cat's resultant behavioural response is to protect themselves and enhance their survival. And which behavioural strategy a cat implements will vary between the individual, but can also change depending on whether they are able to escape or pacify that perceived threat. And in the veterinary setting, avoidance and repelling behaviour are obvious to us, it's easily recognised.
So it's those cats that are hiding or backing away, or those cats that are more vocal and resisting examination. However, when inhibition is the primary response, so those cats, they're still intense and passively gathering information. It can be more difficult to recognise and we sometimes mistakenly misinterpret these cats as good cats.
In practise, we therefore may continue to interact with these cats, and while the examination may be easier, and we can perform more investigations, the cat continues to feel threatened and remains in a protective emotional state. As a result, the cat's behavioural strategy may change to avoidance or repelling the threat. And this of course makes examination much more difficult and increases the risk of injury to everyone involved, including the cat.
And as well as this, with each negative experience, fear anxiety worsens and has a compounded negative effect on future situations. Minimising the number of stresses that cats are exposed to will aid in preventing negative association with vet visits and improved cat well-being, and owner education is crucial to this task. Perhaps this is an area that as vet professionals we could do more.
We mentioned earlier that owners are turning to Doctor Google for advice on their stressed cat. And in one study, 75% of owners reported they hadn't received travel advice from their vet team. And educating clients and referring them to reliable sources of information is something that the whole veterinary team can get involved with.
So what does this look like? Well, it's advising owners on appropriate carrier choices. So one that is sturdy, secure, provides privacy.
That can be dismantled to allow examination of the cat in the carrier. So something like this would be ideal. I'm sure we've all seen these less appropriate carrier choices in practise.
Cat backpacks in particular are gaining in popularity, and these can be associated with stress. This poor cat in the top picture is clearly not looking very comfortable, and there's no privacy, there's no option to hide from visual stressors. And in one survey, 8% of owners said that they transport their cat in a backpack, which might not seem like a lot.
But it's still nearly 1 in 10 owners, and it does appear to be on the rise. As well as carrier choice, it's also advising owners on how to interact with their cat. And that will include advice before vet visits, such as handling techniques and how to implement carrier training.
Perhaps advising the owners to make the carrier accessible to the cat all the time, rather than storing it in the attic or shed. And then advice on the day, simple suggestions such as holding the carrier from the bottom to prevent instability, or using blankets or towels to provide privacy and minimise exposure to visual stressors. And then advice for the car journey, such as turning the radio off or planning their journey in advance to avoid traffic and limit travel time.
And then when they reached the clinic, perhaps asking owners to wait in the car if the waiting room is busy and noisy. We can also optimise the feline experience in the veterinary setting too, with a cat friendly approach. And this will include considerations for the veterinary environment that caters to the needs of the cat.
And adapting how the vet team interacts with cats and promoting friendly handling. Implementing a cat friendly approach offers numerous benefits, including improved feline welfare. Improved owner and vet team satisfaction.
It's likely safer for all, there's improved compliance, it's an easier examination. And it will impact future vet visits positively. In one study, a 2023 study, at friendly practises, when compared to non-cat friendly practises, had a higher owner satisfaction, which contributed to the higher number of vet visits.
And they perform more diagnostic testing which led to identifying a higher number of cats with clinical abnormalities. So there's numerous benefits for doing so. So what does a cat friendly approach look like?
Well, some recommendations, and I hate to use the key word for scheduling cat consultations at quieter times of the day. Making time, which I appreciate is not an easy task in practise, but ideally giving cats time to acclimatise, particularly for say blood pressure checks. Asking owners to complete a pre-visit questionnaire so to better understand the individual cat's needs, and this will also help to prepare and save time.
And of course promoting good handling techniques, so minimal restraint, perhaps use of a loose towel or blankets, and some cats may prefer to be examined within the carrier. And of course educating the team on inappropriate handling techniques such as scruffing or full body restraints. And we know that some handling techniques can cause discomfort, particularly in older cats, but also can further distress, which will negatively impact future vet visits.
And in conjunction with owner education, environmental management and cat friendly interactions, in some cases you may need to reach for anxiolytics. And this is where BOA fits in. So Bonnca is the first licenced feline anxiolytic for acute fear and anxiety associated with transportation and veterinary visits.
Bocat contains pregabalin, 50 mg per mL, as a flavoured oral solution. And it's presented in 2 mil multi-use glass bottles and the dose is 0.1 millilitres per kilo, which means in one bottle there are 5 doses for an average 4 kg cat.
The reason Bomcat is stored in a glass bottle is because plastic is not a suitable material for this type of medicinal product, and it can actually affect the stability and other chemical properties of this solution. Boncat has a shelf life of 6 months once opened, and similarly to Tassie, there is flexibility with storage. So it should be stored in the fridge, but it can be kept at room temperature for up to 1 month.
And Boncat is a Schedule 3 controlled drug. So how does BONA work? Well, pregabalin is a structural analogue of the neurotransmitter GABA.
And in the central nervous system, it binds to the alpha 2 delta subunit of voltage-gated calcium channels. This in turn reduces calcium influx to the cell. And leads to a reduction in the release of several excitatory neurotransmitters such as glutamate.
Which have been implicated to play a role in the pathophysiology of anxiety, so thereby decreasing that level of anxiety. In terms of dosing, as I've mentioned, the dose of Bonca is 0.1 millilitres per kilo.
And this should be administered 90 minutes before travel or the veterinary visits. It has a long duration of action of approximately 7 hours, which is sufficient time to get the cat to the vets and back home again. The small dosing volume and the flavoured oral solution makes dosing easy and aids compliance.
And this was evaluated in the clinical trial. Ultimately reducing stress from the outset, so less stressful for the cat, the owner and the veterinary team. In terms of the clinical trial, more than 200 cats were included, and this was a randomised double blinded, placebo-controlled study.
And this demonstrated success during both transportation and veterinary visits, and you can scan this QR code here to find out more. In terms of efficacy, anxious cats were nearly 4 times more likely to remain calm and quiet during transportation after bong cat compared to the placebo. And vets were over 3 times more likely to easily perform the clinical exam.
In terms of safety, BONcat has a good safety profile, so there were no serious adverse events and no notable laboratory changes. The most common adverse events noted were incoordination in 4 cats and tiredness in 3 cats. And these were also noted to be mild and transient.
So to summarise, Bonncat contains pregabalin, an active ingredient with proven anxiolytic effects in cats. The small dose dosing volume and flavoured solution aids with administration. It has a quick onset of effects and long duration of action.
And ultimately reduces stress for the cat, the owner and the veterinary team. So that was a whistle stop tour of Bunker and Tessie. And before we end this evening's webinar, we thought we would go through some of the more frequently asked questions that we get through our tech lines.
So you're starting with Tessie. Thanks Catherine. So the first thing I wanted to start with was that I mentioned before, the use of a test dose.
So why is this needed and how do we do it? So it's essentially there to reassure the owner and also ourselves of course as prescribers, that the patient does not experience any side effects and it's safe to be left alone, as of course Tessie is licenced for separation. This is only required once, and the dog should be observed by the owner for 2 hours for any problems.
The vast majority of cases are going to be fine, but if the owner does notice any problems, as the effects of testsE are dose dependent, a dose reduction is recommended within the data sheet, where the dose can be reduced by 13%. However, of course, any dose reduction should only be done after the owner has sought veterinary advice, and of course, if you're seeing any problems, we would definitely want you to call us. The second thing I wanted to look at is really because we are quite often asked about this, is because Tessie is an alpha 2, aren't we just sedating the patient?
And it's a bit unfortunate because we usually use alpha 2 agonists in practise as sedatives, as part of our sedation or general anaesthetic protocols. So it's an unfortunate but common misconception that the effects of Tessie are because we're simply sedating the dog. However, at lower alpha 2 doses, like within Tessie.
The the objective is not to sedate the patient, and such doses are considered sub sedative and result instead in anolysis with reduced emotional arousal, AKA calming down the panic response, resulting in a calm but functional patient. And I think it's therefore really important that we also educate the owners as to what to expect from using these medications. And we are certainly not aiming to knock the dog out, for example, every time we leave them, and the efficacy of Tessie is not reliant on sedating a patient.
And finally for Tessie. Is 3 hours long enough for separation problems, for example, if the owner's going to be out all day at work? So first of all, Tessie is expected to last 3 or more hours.
And if we consider it's dual purpose, so for separation, typically separation related behaviours start at the time of the trigger. For example, when an owner signals that impending departure, so prior to them actually leaving, or shortly after that departure. And the, and the maximum level of observable behaviours associated with this, this distress is generally seen within that first hour.
So it's advisable to administer Tessie an hour before departure, meaning that the entire separation runs more smoothly as the anxiety is just not being triggered in the first place. And therefore, the duration of effect, particularly for separation, is not necessarily completely related to its plasma concentration. And for fear of noise, for example, for fireworks, of course the triggers are just constantly there.
So if the owner doses early evening, then one dose is likely to be sufficient. However, if they notice the signs of anxiety are returning, then they are free to top up after that 3 hours. But of course they don't have to if they don't need to, if the dog remains calm.
And it's for these reasons that in the clinical trials, even though the owners were free to dose up to 3 times during a 24 hour period, few needed more than 1 application. So on to BOAt then, and the first question being how does Boncat or pregabalin differ from gabapentin? So, firstly, as pregabalin and gabapentin are both gabapentinoids with the same mode of action, it is expected that they will exert similar effects, and that includes desired effects, but also adverse effects.
Pregabalin is much more potent than gabapentin, however, so it can exert its effects with a much smaller dose. Given the small dosing volume and the fact that it is a flavoured oral solution, the effects of Boncat will likely be much more predictable than gabapentin, where doses of gabapentin vary considerably, 50 to 200 migs per cat. Pregabalin also has a longer half-life in gabapentin, so 14 hours, 4 hours, and so it has a longer duration of action.
And it is absorbed more quickly, and its absorption is linear, whereas gabapentin's absorption becomes saturated with increasing dosage. So moving on to the next question, does BONA affect the clinical examination? And similar to the effects of gabapentin, we do need to be mindful that BONA could affect some parts of the clinical exam, and we need to take that into consideration.
We know from the boat clinical trial that activity level and ability to stand up and walk stay normal in most cats, where 4.6% or 4 cats showed signs of mild transient in coordination. And 2.8% or three cats showed tiredness.
And from the trials we know that there were no notable changes in laboratory values. But as pregabalin has an analgesic effect, it may affect pain assessment. And in the safety studies for bon cat, pregabalin occasionally caused some reduction in body temperature and heart rate in cats.
Also, occasional changes in blood pressure were observed, however, the blood pressure values generally remained within normal physiological range. It is of course important to remember that stress will also affect physiological parameters such as heart rate, respiratory rate, temperature, blood pressure, and of course as well as pain scoring as well. Finally, canon cat be prescribed without seeing the cats?
And the decision to do so will be case dependent and should be based on a risk benefit assessment by the prescribing clinician. Of course, in the interest of animal welfare, prescription of BOA may be justifiable and such justification should be documented within the patient's clinical notes. And we refer you to the undercare guidance provided by the RCVS.
To wrap up, just a quick mention that Dame's Farmer have lots of support material available for the vet team as well as pet owners, and that includes information guides, questionnaires, the ball kits that Emma mentioned earlier, post-prescription leaflets, and, and much more. So please feel free to get in touch or head over to our website where you can download these resources. And you can find these at Dames Farmer.co.uk behind a vet professional login, it's completely free.
Other useful resources include international cat care, of course, and their cat friendly guidelines as shown here. And if you're looking for a list of certified behaviourists, we refer you to these organisations. Just a reminder that we do still have Cellio as part of our anxiety range.
And as always, if you have any questions about any of these products, please do feel free to get in touch with us via phone or email as displayed here. Thank you very much for listening. And these QR codes will take you to the Tassie and Boncat GB summary of product characteristics.
Guys, that was absolutely fantastic. Thank you so much for a really interesting webinar and we have had loads and loads of questions coming in. And I'm very pleased to say that your frequently asked questions section at the end has answered almost all of.
So it's almost like you knew what was frequently. Sort of fits with the name, doesn't it? So that was a brilliant approach.
Really, thank you so much, guys. And a huge big thank you as well, to Domes Farmer for sponsoring this evening, and allowing us to listen to you. If you want more detailed information, as we have just heard from, from Emma and Katherine, please use those QR codes on your screen now.
They will stay up while we're chatting. The other thing to remind everybody is that we are recording the webinar tonight, and the recording will be up on the webinar vet website, within the next 24 or 36 hours. No pressure on the technical guys, but they'll get it up for us.
So, a couple of questions that have not been answered that have come through. And I'm gonna paraphrase because there are a lot and I cannot read all of them out. The question about dosing it, being transmucosal versus swallowing is a big one that's come through, of both products.
And the other one is, on an empty stomach or in food or with food, they're all combined. Sure, I'll probably take this one because I think with the a mucosal application, with the aromucosal application, I think this person is probably asking about Cellio. So just, just to point out some differences.
The main difference between Tessie and Celio is their indication for a starter, but also that, kind of practical differences. So ellio is your aim mucosa application, so the syringe needed or needs to be popped into the kind of cheek pouch so it's delivered to the oromucosa. But Tessie, because it has a much higher oral bioavailability, is swallowed.
So it's not just delivered into the cheek pouch, it is actively swallowed by the patient. And just coming on to the question about feeding, . We know that feeding can delay the absorption of Tessie, and I think as well for bocat too.
And so, particularly for Tessie, the data sheet does recommend that we don't feed the animal one hour before to one hour after administration, just so we don't get any delay. A small treat is fine, just to make sure they've swallowed it and to make positive associations, and of. Of course, water can be freely available, but ideally we would withhold a full meal until those kind of hours have passed.
I think it's similar to boat, isn't it, as well? Yes, so with boat, it's advised not to feed the cat at the same time that you're administering boat, for the same reasons that, well, will have the same effects that they will be delayed, and that makes it very difficult to plan the vet visit. In the clinical trial for Boncat, the owners were advised to syringe Boncas straight into the mouth of the cats.
And actually in the study that they, they found that usability and compliance was, was very good, and they put that down to the small dose in volume, but also the fact that it was a flavoured solution. Fantastic. Interesting question that's come through about storage.
You were mentioning about the type of bottles that they come in and keeping them in the right products and everything else. There was a question that came through about, drawing it up into a syringe, and then maybe the cat legs it or the, the appointment time changes. How long can you keep it in the syringe before you dose it?
So in terms of Boncat, we don't advise you to, to draw it up into other syringes, and that's because we know that plastic is not a suitable material to store bocat in for a long period of time. In terms of using the syringe that comes with bongcats. That's a little bit more difficult to answer because I don't think we have stability for storage of bumca within the syringe.
So I think if you're not going to use it, it would be to put it back in the bottle. Yeah, or to chuck, I think. I think, you know, we just don't, like you said, we just don't have the stability data unfortunately for how long or whether it's OK to keep it in these kind of prefilled syringes.
So I would advise against it and to chuck away if, if you don't use it for some reason. Excellent. A common question that's coming through, there's loads of questions, but what about this and what about that and what we can't go into every drug we'll be here all night.
But a common question is that's coming through is, cats with, with chronic diseases like hyperthyroid or CKD, will it interfere with those conditions and does it help with blood draws on those animals? Say is that bone cat has been studied in healthy cats or those with mild systemic disease. So cats with comorbidity such as renal disease, it, the use of bon cat will be based on an individual risk benefit assessment, .
I think that's all we could there's much to say on it. Yeah, I think it's the same sort of thing goes for Tessie to be honest, so both of these products are licenced in. What we classify as ASA grades 1 and 2.
So, if we remember that ASA grade 2 is that mild, well controlled or asymptomatic disease, so if you've got a patient with a comorbidity, it doesn't necessarily, it's not necessarily a contraindication in itself. Of course, if it's more severe then. You know, we, that may be, so yeah, I think we just have to take it on a case by case, and, you know, based on that kind of physical examination, are they ASA grades too.
Of course we do also have to think about any other medications that those patients might be on and whether there's potential interactions there. I think it's whilst it's a bit of a wishy-washy answer, I think it's a case of, you know, if you've got a specific case in mind, just ping us an email or give us a call and we can just chat you through more specifics, I guess. I think that's a really, really sensible answer rather than wishy-washy because there, there is no such thing as a vet that can say yes or no in every single case, every single possibility and As vets, we are trained and it is a risk-benefit analysis.
So, you know, based on our clinical assessment of that patient, how long we've known it, all those sorts of things, you make a decision based on that. And if you need to call in, you know, professionals like yourself in the know of the company, then go ahead and do it. But having a blanket answer is, is not easy.
I, I completely agree with you. Wasn't my question, by the way. No, that's fine.
It's just hard to say yes or no. Absolutely. Here's another one that's come through.
When you have animals that are on hypoallergenic diets, are these products OK to use for them? I don't believe there's anything in them that is of like animal origin. I think they're all synthetic, so I don't see any reason why this would trigger any sort of food allergies or anything like that.
Yeah. Fantastic. We are running out of time, so I'm only going to give one more question, which is again a collaboration of 4 or 5 or 6 others.
. Even though these products may not well be licenced for them, have there been benefits shown for other conditions? For example, travel anxiety or fear of cars and movement and that sort of thing? Do you find that, testy would help in those cases for dogs, for example?
That's a really good question. So I always have to refer back, regulator will tell me, I always have to refer back to its licenced indications, so of course it's licenced for noise and owner departure, and if therefore you're looking to kind of use Tessie for any other anxieties that would be off licence, and so clinicians should look at what is most applicable in terms of the prescribing cascade. Obviously there's not that many aniolytics out there that are licenced for dogs, so it may provide you an option on the cascade, but of course it might be off licence and therefore off licence consent should be obtained.
But, you know, there's, there's not really a reason in terms of its mode of action, that we couldn't use that, and it could be a potential, but as I said, it would be off licence, we'd have to look at the cascade. Fantastic. And again, as you say, off-license use, if you as a licenced veterinarian are sure that your patient doesn't have any contraindications, discuss off licence, get them to put their squiggle on an off-license form and try it.
Yeah, but it's a risk assessment. Last question, I promise this is the last one. We like.
We've had a field, but there are a couple of questions about availability as well. Can you give our audience an indication of where your products are available? We can try, so of course we're speaking on behalf of Jones Farmer UK.
So for us, we are, the distributors for these two products in Great Britain only unfortunately. It might be worth, I mean, you can always send us an email to see whether our Jones Farmer kind of France or or any other subsidiaries in in Europe might be a possible place to look for. Alternatively, you could also contact the manufacturer Orion, if we're looking more further afield, for instance, to see whether there's any options for distribution in in those particular countries.
Sorry, I can't be of more help than that. I think that is a great or they're gonna know if somebody like you said, these guys, they might help you in America or Australia or wherever. So, yeah, fantastic.
Ladies, it has been an absolute pleasure to host this webinar with you tonight. It has been hugely informative and I'm sure that our participants have enjoyed it as much as I have. So once again, a big thank you to Domes Farmer for their sponsorship and a big thank you to both of you, Emma and Katherine, for your time and for your excellent presentations tonight.
Thank you. Thank you. To everybody who attended, thank you so much for all your time tonight.
I hope you did enjoy it. To Beck in the background, my controller for making everything run smoothly. Thank you to you and from myself, Bruce Stevenson, it's goodnight.
