EXPRESS: Treatment of non-effusive feline infectious peritonitis using oral remdesivir or GS-441524: a randomized, double-blind noninferiority trial.

Oral remdesivir and GS-441524 are both effective for non-effusive FIP; relapse monitoring needed.

This randomized, double-blind, noninferiority trial compared oral remdesivir versus GS-441524 for treating non-effusive feline infectious peritonitis (FIP), a fatal disease caused by feline coronavirus. Twenty cats were randomly assigned to receive either remdesivir (38-42 mg/kg, n=10) or GS-441524 (18-22 mg/kg, n=10) once daily for 84 days. At week 16, 90% of remdesivir-treated cats and 70% of GS-441524-treated cats were alive and in clinical remission, with a 20% difference between groups (90% CI: -8.5-48.5%). All treatment failures occurred within the first 11 days. Long-term follow-up at 1.5-2 years post-treatment identified potential disease relapse in 4 cats (2 per group). Both antivirals demonstrated efficacy as first-line treatments for non-effusive FIP. However, the study raises important concerns about late disease relapse, warranting further investigation into optimal treatment duration, relapse rates, and management strategies for previously treated cats.

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