Evaluation of the analgesic efficacy of grapiprant compared with robenacoxib in cats undergoing elective ovariohysterectomy in a prospective, randomized, masked, non-inferiority clinical trial.

OBJECTIVES: The main objective of this study was to compare the postoperative analgesic effects of grapiprant with those of robenacoxib in cats undergoing ovariohysterectomy (OVH). METHODS: In total, 37 female cats (age range 4 months-10 years, weighing ⩾2.5 kg) were enrolled in a prospective, randomized, masked, non-inferiority (NI) clinical trial. Cats received oral robenacoxib (1 mg/kg) or grapiprant (2 mg/kg) 2 h before OVH. Analgesia was assessed via the Feline Grimace Scale (FGS), the Glasgow Composite Measure Pain Scale-Feline (CMPS-F), von Frey monofilaments (vFFs) and pressure algometry (ALG) 2 h before treatment administration, at extubation, and 2, 4, 6, 8, 18 and 24 hours after extubation. Hydromorphone (<8 h postoperatively) or buprenorphine (>18 h postoperatively) were administered to cats with scores of ⩾5/20 on CMPS-F and/or ⩾4/10 on FGS. NI margins for CMPS-F and vFFs were set at 3 and -0.2, respectively. A mixed-effect ANOVA was used for FGS scores (P <0.05). Data are reported as mean ± SEM. RESULTS: The data from 33 cats were analyzed. The upper limit of the 95% confidence interval (CI) (0.35) was less than the NI margin of 3 for CMPS-F, and the lower limit of the 95% CI (0.055) was greater than the NI margin of -0.2 for vFFs, indicating NI of grapiprant. The FGS scores were greater than baseline at extubation for both treatments (1.65 ± 0.63; P = 0.001); however, there was no difference between treatments. There was no difference between treatments, nor treatment by time interaction, for vFFs (P <0.001). The CMPS-F scores for both treatments were higher at extubation but returned to baseline after 4 h (P <0.001). For ALG, there was no difference in treatment or treatment by time interaction. The robenacoxib group had lower pressure readings at extubation and 6 h compared with baseline. CONCLUSIONS AND RELEVANCE: These results indicate that grapiprant was non-inferior to robenacoxib for mitigating postsurgical pain in cats after OVH performed via ventral celiotomy. The impact of grapiprant for analgesia in OVH via the flank is unknown.

Evaluation of the perioperative analgesic effects of grapiprant compared with carprofen in dogs undergoing elective ovariohysterectomy.

OBJECTIVE: To evaluate and compare postoperative analgesic effects of grapiprant and carprofen in dogs undergoing ovariohysterectomy. ANIMALS: 42 sexually intact female healthy dogs (< 35 kg and 0.5 to 7 years old) were enrolled. PROCEDURES: In a masked, randomized, noninferiority clinical trial, dogs received either 2 mg/kg of grapiprant or 4.4 mg/kg of carprofen orally 2 hours prior to ovariohysterectomy. Postoperative pain was assessed using the Glasgow Composite Pain Scale-Short Form (GCPS-SF) at extubation and 2, 4, 6, 8, 18, and 24 hours postextubation and compared to baseline. After each pain scoring, mechanical nociceptive testing with von Frey monofilaments (vF) was performed to assess hyperalgesia. Hydromorphone (0.05 mg/kg, IM) was administered to any dog with a GCPS-SF of ≥ 5/24. The noninferiority limit (NI) for the GCPS-SF was Δ = 3. The NI for vF was Δ = -0.2. Following noninferiority, a mixed-effect ANOVA and post hoc comparisons were made with the Tukey correction method (P < .05). RESULTS: 3 dogs required rescue analgesia and were excluded from statistical analysis. Of the remaining 39 dogs, the upper CI for GCPS-SF was below the NI of 3 and the lower CI for vF was greater than the NI of -0.2, indicating noninferiority of grapiprant as compared to carprofen. There was no difference between treatment (P = .89) nor treatment by time (P = .62) for GCPS-SF. There was no difference between groups at any time point or over time when vF were used. CLINICAL RELEVANCE: Our study results support the use of grapiprant as an analgesic alternative to carprofen in dogs undergoing ovariohysterectomy.

Socioeconomic determinants of geographic disparities in campylobacteriosis risk: a comparison of global and local modeling approaches.

BACKGROUND: Socioeconomic factors play a complex role in determining the risk of campylobacteriosis. Understanding the spatial interplay between these factors and disease risk can guide disease control programs. Historically, Poisson and negative binomial models have been used to investigate determinants of geographic disparities in risk. Spatial regression models, which allow modeling of spatial effects, have been used to improve these modeling efforts. Geographically weighted regression (GWR) takes this a step further by estimating local regression coefficients, thereby allowing estimations of associations that vary in space. These recent approaches increase our understanding of how geography influences the associations between determinants and disease. Therefore the objectives of this study were to: (i) identify socioeconomic determinants of the geographic disparities of campylobacteriosis risk (ii) investigate if regression coefficients for the associations between socioeconomic factors and campylobacteriosis risk demonstrate spatial variability and (iii) compare the performance of four modeling approaches: negative binomial, spatial lag, global and local Poisson GWR. METHODS: Negative binomial, spatial lag, global and local Poisson GWR modeling techniques were used to investigate associations between socioeconomic factors and geographic disparities in campylobacteriosis risk. The best fitting models were identified and compared. RESULTS: Two competing four variable models (Models 1 & 2) were identified. Significant variables included race, unemployment rate, education attainment, urbanicity, and divorce rate. Local Poisson GWR had the best fit and showed evidence of spatially varying regression coefficients. CONCLUSIONS: The international significance of this work is that it highlights the inadequacy of global regression strategies that estimate one parameter per independent variable, and therefore mask the true relationships between dependent and independent variables. Since local GWR estimate a regression coefficient for each location, it reveals the geographic differences in the associations. This implies that a factor may be an important determinant in some locations and not others. Incorporating this into health planning ensures that a needs-based, rather than a "one-size-fits-all", approach is used. Thus, adding local GWR to the epidemiologists' toolbox would allow them to assess how the impacts of different determinants vary by geography. This knowledge is critical for resource allocation in disease control programs.

Detection of high risk campylobacteriosis clusters at three geographic levels.

Campylobacteriosis is a leading cause of bacterial gastroenteritis in the United States and many other developed countries. Understanding the spatial distribution of this disease and identifying high-risk areas is vital to focus resources for prevention and control measures. In addition, determining the appropriate scale for geographical analysis of surveillance data is an area of concern to epidemiologists and public health officials. The purpose of this study was to (i) compare standardized risk estimates for campylobacteriosis in Tennessee over three distinct geographical scales (census tract, zip code and county subdivision), and (ii) identify and investigate high-risk spatial clustering of campylobacteriosis at the three geographical scales to determine if clustering is scale dependent. Significant high risk clusters (P <0.05) were detected at all three spatial scales. There were overlaps in regions of high-risk and clusters at all three geographic levels. At the census tract level, spatial analysis identified smaller clusters of finer resolution and detected more clusters than the other two levels. However, data aggregation at zip code or county subdivision yielded similar findings. The importance of this line of research is to create a framework whereby economically efficient disease control strategies become more attainable through improved geographical precision and risk detection. Accurate identification of disease clusters for campylobacteriosis can enable public health personnel to focus scarce resources towards prevention and control programmes on the most at-risk populations. Consistent results at multiple spatial levels highlight the robustness of the geospatial techniques utilized in this study. Furthermore, analyses at the zip code and county subdivision levels can be useful when address level information (finer resolution data) are not available. These procedures may also be used to help identify regionally specific risk factors for campylobacteriosis.