Comparison of Selected Therapies Within the Step-Up Therapeutic Approach in Canine Chronic Inflammatory Enteropathy

Canine chronic inflammatory enteropathy (CIE) frequently requires a sequential therapeutic approach in which treatment is escalated according to clinical response. This prospective, open-label clinical study evaluates selected dietary, antimicrobial, microbiome-directed, and corticosteroid interventions used within a step-up treatment strategy in dogs with CIE under routine clinical conditions. Fifty-six dogs were enrolled. Clinical response was assessed using the Canine Chronic Enteropathy Clinical Activity Index (CCECAI), together with faecal calprotectin, serum folate, and serum cobalamin concentrations. In the dietary stage, both novel-protein and hydrolysed diets significantly reduced CCECAI and faecal calprotectin. Clinical remission, defined as a final CCECAI score ≤ 3, was achieved in 64% and 60% of dogs, respectively. Baseline-adjusted analyses likewise showed no significant between-group differences in CCECAI, faecal calprotectin, or cobalamin. In dogs receiving second-line treatment, both metronidazole and probiotics combined with fibre significantly reduced CCECAI and faecal calprotectin, while baseline-adjusted comparisons demonstrated no significant differences between treatments for the evaluated outcome. In dogs receiving corticosteroid-containing treatment, substantial numerical reductions in CCECAI and faecal calprotectin were observed in both the prednisone-containing and budesonide-containing regimens; however, the very small subgroup sizes and concomitant dietary, probiotic, and fibre interventions precluded definitive conclusions regarding the specific effects or comparative efficacy of the individual corticosteroids. These findings provide real-world clinical evidence supporting a structured step-up approach to canine CIE and provide a rationale for larger, adequately powered controlled studies to determine whether non-antibiotic microbiome-directed strategies and locally acting corticosteroid-containing therapy can reduce reliance on empirical antimicrobial treatment and systemic corticosteroids, thereby minimising the potential adverse consequences associated with these therapies.