Gingivostomatitis in cats refractory to extraction: does ciclosporin improve oral pain and inflammation scores? — POSSIBLE

In cats with gingivostomatitis refractory to extraction, does ciclosporin vs placebo improve oral pain and inflammation scores?

Shelf #757 · gate-verified and displayed under the developer's blinded-trial rule

POSSIBLE: One randomised, placebo-controlled, double-blinded trial (Lommer 2013) answers this question directly in exactly the refractory population: 16 cats with chronic stomatitis that had already undergone premolar-molar or full-mouth extraction. On ciclosporin (spelled cyclosporine in the record) 2.5 mg/kg orally twice daily for 6 weeks, mean improvement in the 30-point Stomatitis Disease Activity Index (SDAI) was 52.7%, versus 12.2% on placebo, and 7 of 9 treated cats (77.8%) achieved a greater-than-40% SDAI improvement versus 1 of 7 placebo cats (14.3%) — a relative responder ratio of about 5.4, with the absolute proportions alongside; both differences were statistically significant in the record. Cats whose trough whole-blood ciclosporin levels exceeded 300 ng/mL improved more (72.3%) than cats below that level (28.2%), but absorption varied widely between cats (troughs 32.1–1,576.2 ng/mL). Design class (a): randomisation and blinding are both established by the carded record's own wording — its title states 'A randomized, placebo-controlled, double-blinded clinical study', its abstract states cats 'were randomly assigned' and that 'neither the clinician nor the clients were aware of the group assignments', and its publication types include Randomized Controlled Trial. Why POSSIBLE and not more: the effect is large and directly on-question, but the trial is a single study of 16 cats over 6 weeks — too small to clear the PROBABLE bar for a decisive single trial, and blood-level variability means the delivered dose and the achieved exposure are loosely linked. The honest limits: refractory post-extraction cats only (nothing here about ciclosporin instead of extraction), a composite clinical score rather than a hard outcome, and no longer-term placebo-controlled follow-up on this shelf. Distinct disease home from Shelf #275 (ciclosporin for feline allergic skin disease); neither of #275's records (PMID: 22882582; PMID: 18294881) is carded here, and this shelf's record is not carded there. Drafted Nov 10, 2026 (VetMed build, topic #757); all figures from the abstract fetched and verified at drafting.

Lommer 2013: in 16 post-extraction refractory stomatitis cats, ciclosporin improved SDAI scores by a mean of 52.7% vs 12.2% on placebo at 6 weeks, with greater-than-40% improvement in 7 of 9 treated cats (77.8%) vs 1 of 7 (14.3%) on placebo

Randomised, placebo-controlled, double-blinded clinical study (record's own title wording: 'A randomized, placebo-controlled, double-blinded clinical study'; abstract: cats 'were randomly assigned a group to receive 2.5 mg/kg cyclosporine or placebo'; publication type: Randomized Controlled Trial)

Who: Cats: 16 cats with chronic stomatitis that had previously undergone premolar-molar or full-mouth extractions (the refractory, post-extraction population). Cats were randomly assigned to receive ciclosporin (record spelling: cyclosporine) 2.5 mg/kg or placebo, orally, twice daily; neither the clinician nor the clients were aware of the group assignments (9 cats in the treatment group, 7 in the placebo group, per the results). Cats were evaluated before treatment and every 2 weeks for 6 weeks using a 30-point Stomatitis Disease Activity Index (SDAI) score.

Result: Mean improvement in SDAI scores after 6 weeks was 52.7% in the treatment group, significantly different from the mean improvement of 12.2% in the placebo group. During the 6-week study period, 7 of 9 cats in the treatment group (77.8%) showed a greater-than-40% improvement in SDAI score, while 1 of 7 cats in the placebo group (14.3%) did — a relative responder ratio of about 5.4, with the absolute proportions alongside — and this difference was statistically significant. Individual variability in absorption of orally administered ciclosporin was high: trough whole-blood levels ranged from 32.1 ng/mL to 1,576.2 ng/mL. Cats with trough levels above 300 ng/mL improved significantly more (72.3% improvement) than cats with levels below 300 ng/mL (28.2% improvement), and levels above 300 ng/mL were associated with significant improvement in oral inflammation.

Watch out: Sixteen cats and 6 weeks: the effect is large but the sample is very small, and the wide spread of achieved blood levels (32.1–1,576.2 ng/mL on the same mg/kg dose) means some treated cats were effectively underexposed — the level-stratified result (>300 ng/mL: 72.3% improvement; <300 ng/mL: 28.2%) is a within-trial subgroup split, not a randomised comparison. The record's MeSH list includes Cross-Over Studies, but the abstract reports the 6-week parallel-group comparison and no crossover-phase results, so nothing on this card rests on a crossover phase. This is a post-extraction refractory population only — the trial does not test ciclosporin as an alternative to extraction.

Lommer MJ. Efficacy of cyclosporine for chronic, refractory stomatitis in cats: A randomized, placebo-controlled, double-blinded clinical study. J Vet Dent. 2013;30(1):8-17. PMID: 23757820. Registry ID: none in the record. MeSH: Administration, Oral · Animals · Body Weight · Cat Diseases/blood, drug therapy* · Cats · Chronic Disease · Cross-Over Studies · Cyclosporine/administration & dosage, blood, therapeutic use* · Dental Prophylaxis/veterinary · Dental Scaling/veterinary · Double-Blind Method · Follow-Up Studies · Gingivitis/blood, drug therapy, veterinary · Immunosuppressive Agents/administration & dosage, blood, therapeutic use* · Placebos · Remission Induction · Stomatitis/blood, drug therapy, veterinary* · Tooth Extraction/veterinary · Treatment Outcome

Synthesis: one small randomised double-blinded placebo-controlled trial in post-extraction refractory stomatitis found substantially greater SDAI improvement on ciclosporin — POSSIBLE

Synthesis

Who: Synthesis of the card above: Lommer 2013 (16 cats with chronic stomatitis refractory after premolar-molar or full-mouth extraction; ciclosporin 2.5 mg/kg orally twice daily versus placebo for 6 weeks; 30-point SDAI scored every 2 weeks).

Result: (1) Mean SDAI improvement at 6 weeks: 52.7% on ciclosporin versus 12.2% on placebo (statistically significant). (2) Greater-than-40% SDAI improvement: 7/9 (77.8%) versus 1/7 (14.3%) (statistically significant; relative ratio about 5.4, absolute proportions alongside). (3) Exposure mattered within the trial: trough whole-blood levels above 300 ng/mL were associated with 72.3% improvement versus 28.2% below that level, against a very wide absorption range (32.1–1,576.2 ng/mL). No other placebo-controlled PubMed record for ciclosporin in feline gingivostomatitis was found at drafting; the later long-term literature retrieved (for example a 2025 series of ciclosporin combined with interferon-ω in refractory cases, PMID: 41402880) is uncontrolled and combines two drugs, so it cannot attribute an effect to ciclosporin versus placebo and is not carded here.

Watch out: A one-trial, 16-cat shelf: POSSIBLE reflects a large, directly on-question effect in a very small sample, not settled evidence. It does not cover ciclosporin before or instead of extraction, other gingivostomatitis treatments, or outcomes beyond 6 weeks, and its disease home is distinct from Shelf #275 (ciclosporin for feline allergic skin disease) — the same drug in a different disease, with no records shared between the shelves.

Synthesis of Lommer MJ. PMID: 23757820. Registry ID as on the individual card.

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