Received: 9 November 2022 Accepted: 13 July 2023

DOI: 10.1111/jvim.16832

CASE REPORT

Molnupiravir treatment of 18 cats with feline infectious

peritonitis: A case series

Okihiro Sase

You-Me Animal Hospital, Sakura, Japan

Abstract
Correspondence
Background: Feline infectious peritonitis (FIP) is a viral disease in cats, caused by
Okihiro Sase, You-Me Animal Hospital,
Sakura-shi, Ojidai 4-14-12, Chiba, Japan. certain strains of coronavirus and has a high case fatality rate.
Email: info@sasetch.com
Objective: This case series reports the outcomes of treatment of cats with FIP using
Funding information molnupiravir.
Tiger Funding
Animals: Eighteen cats diagnosed with FIP at the You-Me Animal Clinic, Sakura-shi,
Japan between January and August 2022, and whose owners gave informed consent
to this experimental treatment.
Methods: For this prospective observational study, molnupiravir tablets were com-
pounded in-house at the You-Me Animal Clinic. Owners administered 10-20 mg/kg
PO twice daily. Standard treatment duration was 84 days.
Results: Among 18 cats, 13 cats had effusive FIP and 5 had noneffusive FIP. Three
cats had neurological or ocular signs of FIP before treatment. Four cats, all with effu-
sive FIP, died or were euthanized within 7 days of starting treatment. The remaining
14 cats completed treatment and remained in remission at the time of writing
(139-206 days after starting treatment). Elevated serum alanine transaminase (ALT)
activity was found in 3 cats, all at Days 7-9, and all recovered without management.
Two cats with jaundice were hospitalized, 1 during treatment (Day 37) and 1 with
severe anemia at the start of treatment.
Conclusions and Clinical Importance: This case series suggests that molnupiravir
might be an effective and safe treatment for domestic cats with FIP at a dose of
10-20 mg/kg twice daily.

KEYWORDS
antiviral, FIP, outcomes, treatment

1 | INTRODUCTION

Abbreviations: A/G ratio, albumin-to-globulin ratio; ALT, alanine transaminase; BUN, blood
Feline infectious peritonitis (FIP) is a viral infectious disease mainly
urea nitrogen; COVID-19, coronavirus disease 2019; FcoV, feline coronavirus; FIP, feline occurring in domesticated cats.1,2 FIP is an aberrant immune response
infectious peritonitis; FNA, fine needle aspiration; HCT, hematocrit; RT-PCR, reverse
to infection by feline coronavirus (FCoV), which is ubiquitous, espe-
transcriptase polymerase chain reaction; SARS-CoV2, severe acute respiratory syndrome
coronavirus 2; US, ultrasound; α1AG, α1-acid glycoprotein. cially in breeding and rescue catteries, usually with no to mild

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any
medium, provided the original work is properly cited and is not used for commercial purposes.
© 2023 The Author. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.

1876 wileyonlinelibrary.com/journal/jvim J Vet Intern Med. 2023;37:1876–1880.

 19391676, 2023, 5, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jvim.16832 by Nat Prov Indonesia, Wiley Online Library on [28/11/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SASE 1877

clinical signs. Fecal-oral transmission of FCoV frequently occurs Abdominal or pleural effusion samples (1 mL each) were collected by
especially in multi-cat environments,3 and the incidence of FIP in cats ultrasound-guided abdominocentesis or thoracentesis, respectively,
4,5
exposed to FCoV is up to 14%. and assessed for total nucleated cell count, protein content, A/G ratio,
Feline infectious peritonitis is typically categorized, based on its and cytology. Whole blood samples (1 mL) were collected and shipped
clinical presentation, as either an effusive or a noneffusive form.1,6,7 in ethylenediaminetetraacetic acid (EDTA) tubes.
Until the development of specific antiviral therapy, case fatality asso-
ciated with FIP was high and the majority of affected cats die within
weeks to months after clinical signs appear. 2.2 | Drug preparation
Some nucleoside analogues, including remdesivir (GS-5734) and
its active metabolite, GS-441524,8 inhibit the synthesis of viral RNA Tablets containing molnupiravir 20 mg were compounded in-house at
9,10
and have high antiviral activity against FCoV causing FIP in cats. the You-Me Animal Clinic. In brief, molnupiravir powder was removed
Despite expectations from veterinarians and cat owners, the devel- from 20 commercially sourced molnupiravir 200 mg capsules
oper decided not to seek marketing approval for GS-441524 for the (MOVFOR, Batch No. HH2201001 [HETERO HEALTHCARE, Hydera-
treatment of FIP. As a result, many cats with FIP are treated with non- bad, India]) and mixed with cellulose powder (Microcrystalline Cellu-
approved GS-441524 and concerns have been raised regarding the lose powder, NICHIGA, Takasaki, Japan) using a mortar and pestle
quality, purity, and potency of nonapproved products that are avail- (Matsuyoshi Medical Instruments Co, Ltd, Tokyo, Japan) to make a
able on the global market. Mutian has excellent efficacy and total of 12 g of powder mix [Correction added after first online publi-
safety.11-14 Although the chemical structure of the active ingredient cation on 1 September 2023. The word MOVFORE changed to MOV-
and its accurate concentration have not been disclosed by the manu- FOR.]. The powder was shaped into approximately 200 6-mm wide
facturer, its active ingredient is GS-441524.12 tablets with a secant line, using a generic tablet press made in China.
Molnupiravir is a nucleoside antiviral prodrug suitable for oral
administration, with activity against severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 2.3 | Treatment
(COVID-19), and has been approved in Japan since 2021 for the treat-
ment of people with COVID-19. Reports on the efficacy and safety of Treatment with molnupiravir was initiated when FIP was highly sus-
molnupiravir in cats are published,15 but there is a lack of sufficient pected based on clinical presentation or when FCoV RNA was
data for the use of molnupiravir in cats with FIP. Given the lack of detected with PCR; this date was designated as the first visit. The fol-
treatment options for FIP, we began offering clients at our clinic mol- lowing doses were chosen: 20 mg/kg/d (as 10 mg/kg twice daily) for
nupiravir, using small tablets compounded in-house to allow easy cats with the effusive type, 30 mg/kg/d (15 mg/kg twice daily)
administration in small cats. Reported here are the results from the for cats with the noneffusive type and cats with pyogranulomatous
first 18 cats to receive this treatment for FIP at our clinic. lesions, and 40 mg/kg/d (20 mg/kg twice daily) for cats with neuro-
logical or ocular signs of FIP. The dose could be increased or
decreased in animals that showed evidence of clinical worsening
2 | MATERIALS AND METHODS or adverse events, respectively. The dose was chosen based on the
estimated animal dosages reported online,16,17 and on the adult
2.1 | Cats human dose of molnupiravir for COVID-19, which is 800 mg every
12 hours.18 This would equate to a per kilogram dose of between
All cats attending the You-Me Animal Clinic, Sakura-shi in Japan from 10 and 13.3 mg/kg twice daily for adults weighing 60 to 80 kg. As
January 2022, that were diagnosed with FIP and whose owners gave there is no pharmacokinetic information with cats, we chose the dose
informed consent, were included in this case series. Feline infectious for cats under the assumption that feline drug metabolism is equiva-
peritonitis was diagnosed by a combination of clinical signs (decreased lent to that of humans.
appetite, enlarged abdominal lymph nodes, weight loss, fever, effusions, Owners were instructed to administer the tablets twice daily with
or uveitis) and laboratory test results for anemia and hyperglobulinemia, 12 hours between doses. The predetermined standard treatment
including albumin-to-globulin (A/G) ratio and α1-acid glycoprotein duration was 84 days, as per the GS-441524 study.10
(α1AG) values. A presumptive diagnosis of FIP was based on identifica-
tion of FCoV RNA in samples from an abdominal or pleural effusion
(effusive) or whole blood (noneffusive), or from fine needle aspiration 2.4 | Measurements
(FNA) of pyogranulomatous lesions. Viral detection was undertaken
using reverse transcription polymerase chain reaction (RT-PCR) at the Owners were instructed to record body weight, body temperature,
following test laboratories: abdominal effusion and FNA samples at the physical activity, appetite, and defecation/urination each day, and
IDEXX Laboratory, Japan (using LightCycler 480 System II, Roche Diag- were asked to visit the clinic at Weeks 1, 2, 6, and 10. At each visit,
nostics K.K., Basel, Switzerland) and whole blood at the Canine Lab., the following laboratory tests were required: red and white blood cell
Japan (using CFX Connect, Bio-Rad Laboratories, Inc, Irvine, CA, USA). counts, hemoglobin, hematocrit (HCT), α1AG, total protein, albumin,
 19391676, 2023, 5, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jvim.16832 by Nat Prov Indonesia, Wiley Online Library on [28/11/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
1878 SASE

aspartate transaminase (AST), alanine transaminase (ALT), total biliru- TABLE 1 Baseline characteristics of the cats in this case series.
bin, creatinine, blood urea nitrogen (BUN), and A/G ratio. Samples Cats with
were analyzed at the clinic using a Catalyst One Chemistry Analyzer FIP (n = 18)
and ProCyte One Hematology Analyzer (both IDEXX Laboratories, Age at disease onset, months, median (range) 6.5 (3-93)
Westbrook, Maine). The A/G ratio was determined from either a Breed, n (%)
whole blood plasma or fractionated protein sample. We conducted
Domestic mixed-breed 9 (50.0)
ultrasound assessments of the abdomen and chest of each cat at the
Exotic shorthair 2 (11.1)
start of treatment and after 2, 6, and 10 weeks of treatment, using a
British shorthair 2 (11.1)
Prosound α7 device (Aloka, Japan), including assessment of cardiac
Other 5 (27.8)
function (fractional shortening, ratio of left atrial to aortic diameter,
Sex, n (%)
and valve regurgitation).
Male entire/male neutered 4 (22.2)/7 (38.9)
Female entire/female neutered 2 (11.1)/2 (11.1)

2.5 | Adverse events Weight, kg, mean (SD) 2.72 (0.77)

Duration from disease onset to treatment,a 16.5 (2-49)
Any unusual laboratory test values or health events that occurred dur- days, median (range)

ing treatment were considered adverse events and a determination Effusive type, n (%) 13 (72.2)
regarding treatment continuation/discontinuation was made. Pyogranulomatous lesion in abdomen, n (%) 5 (27.8)
Neurological signs of FIP, n (%) 2 (11.1)
Ocular signs of FIP, n (%) 1 (5.6)
2.6 | Statistical analysis 
Temperature, C, mean (SD) 39.3 (0.9)
Hematocrit, %, mean (SD) 27.3 (8.1)
As this is a case series, no statistical calculations were performed
Albumin/globulin ratio, mean (SD) 0.35 (0.10)
other than descriptive statistics.
Sample type, n (%)
Abdominal effusion 11 (61.1)
Pleural effusion 1 (5.6)
2.7 | Ethics
FNA of pyogranulomatous lesion 2 (11.1)
Whole blood 3 (16.7)
All owners provided written informed consent before initiation of
treatment. Experimental use of molnupiravir was approved by our None 1 (5.6)

institutional animal study review board. Abbreviations: FIP, feline infectious peritonitis; FNA, fine needle
aspiration.
a
Based on owner's report of when signs of illness first appeared.

3 | RESULTS
treated with oral ursodeoxycholic acid (Towa, Japan) 10-15 mg twice
3.1 | Disease and treatment characteristics daily to reduce bilirubin levels. There was no evidence of intravascular
hemolysis (HCT remained stable) and microscopic examination of
Eighteen cats had completed treatment by August 4, 2022, and are blood smears was negative for hemotropic mycoplasma infection.
included in this report. The clinician in charge decided to extend treatment to 99 days
The presentation of the 18 cats is summarized in Table 1 and for Cat #1. This cat developed disturbed consciousness on Day 8 and
Table S1. Median age was 6.5 (range: 3-93) months. All 18 cats had a the dose was subsequently increased to 40 mg/kg. This sign disap-
low serum A/G ratio, 16 had appetite loss, and 14 had mild to severe peared on Day 15; however, the A/G ratio with a fractionated protein
anemia according to hemoglobin and HCT levels. Thirteen cats had sample did not return to normal. At Day 99, although the A/G ratio
effusive FIP and 5 cats had noneffusive FIP. Neurological or ocular was still below the reference range (0.6), the clinician decided to dis-
signs indicative of FIP were present in 3 cats before treatment, includ- continue treatment, as the cat was showing no clinical progression or
ing epileptic seizure/neurologic signs (#8), blunting of postural deterioration.
reflexes (#10), and slow pupillary reflex (#18) (Table S1). All but 2 cats
(#8 and #15) were treated entirely on an outpatient basis. Cat #8 was
hospitalized from Day 37 for 3 days because of jaundice. Cat #15 3.2 | Outcomes
required hospitalization for 5 days upon treatment initiation, because
of anemia and jaundice, accompanied by elevated bilirubin concentra- The clinical response in 14 cats was rapid. Doses, findings during the
tion and ALT activity. During hospitalization, the cat received molnu- treatment, and outcomes in these animals are summarized in
piravir as planned, and was hydrated with Ringer's solution and Tables S2 and S3. Fever resolved and appetite recovered within
 19391676, 2023, 5, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jvim.16832 by Nat Prov Indonesia, Wiley Online Library on [28/11/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SASE 1879

2-3 days after the first treatment. Remissions were achieved, even in neurological/ocular signs of the disease, with the dose increased to
the cats with severe clinical signs. These included Cat #8, #17, and 12 mg/kg PO every 12 hours for cats that develop ocular or neurolog-
#18 who each had ≥2 cm pyogranulomatous lesions, Cat #4 who had ical signs of FIP.17 Others recommend the dose as 25 mg/kg every
severe anemia and a low A/G ratio, Cat #14 who had pleural effusion 24 hours for dry/wet FIP, 37.5 mg/kg every 24 hours for ocular FIP,
and labored breathing, and Cat #15 who had an enlarged kidney. and 50 mg/kg every 24 hours for neurological FIP.16 Because none of
Pyogranulomatous lesions reduced in size or became undetectable on these dose recommendations were determined in prospective con-
ultrasound in all 5 cases and laboratory values in all cats returned to trolled studies, the dose in this case series was determined by the
normal. Three cats presented with neurological signs of FIP before author according to these estimates, the adult human dose and his
treatment. Cat #12 had no neurological signs of FIP before treatment experience. Nevertheless, the dosage used in our case series
but had an epileptic seizure on Day 7. The dosage was subsequently (10 mg/kg twice daily for cats with effusive FIP, 15 mg/kg twice daily
increased to 40 mg/kg. Anisocoria was detected by slit lamp in Cat #7 for cats with noneffusive FIP or pyogranulomatous lesions, and
on Day 2, likely related to uveitis. The molnupiravir dosage was 20 mg/kg twice daily for cats with neurological or ocular signs of FIP)
increased to 40 mg/kg from Day 15, and all neurological or ocular appears to be effective and safe, and might help to inform the dosages
signs of FIP resolved within 15 days. used in future clinical studies.
Of the 14 cats that achieved remission, no relapses had occurred Four cats died during this study. Each of these cats had the effusive
by August 3, 2022, during 55 to 107 days of follow-up after treatment FIP type; however, when considering that some surviving cats had signs
discontinuation. Three cats died (#2, #11, and #16) and 1 (#13) was that were as severe, or even more severe, than the cats that died, no signs
euthanized; these cats all had the effusive form of FIP, but did not were found that were predictive of an early death. Unfortunately, the
have any neurological or ocular signs of the disease. All died within treating veterinarian received little information regarding the deaths of
1 week of treatment initiation. the 3 cats that died at home, and no postmortem examinations were per-
formed. One cat (#2) died after vomiting the drug on Day 6, so it is possi-
ble that this animal had difficulty swallowing.
3.3 | Safety Use of GS-441524 in 31 cats with FIP, of which 26 cats completed at
least 12 weeks of treatment, resulted in 25 achieving remission.10 Eight
Alanine transaminase activity above the reference value was found in out of 26 cats relapsed or were reinfected within 3 to 84 days after this
4 cats; the value of each was 286 U/L (Cat #8 on Day 37), 283 U/L period. The duration of follow-up in our case series is shorter than in the
(Cat #9 on Day 9), 154 U/L (Cat #10 on Day 7), and 117 U/L (Cat #17 GS-441524 study10; however, follow-up of the cats in our series is cur-
on Day 9). The 3 cats that developed an early ALT increase on Days rently ongoing and more cats with FIP are being treated with molnupiravir.
7-9 recovered without management. Cat #8 developed jaundice on Further observation will provide longer term efficacy data. Major adverse
Day 37 and was treated as an inpatient for 3 days. events reported for injection of GS-441524 study were injection site reac-
No abnormalities in BUN or creatinine concentrations were noted tions, in 16 of 26 cats.10 As the treatment in our study was orally adminis-
during molnupiravir treatment. tered, no cats in our series experienced injection site reactions. In our
series, the most common adverse event during treatment was an increase
in ALT activity. However, longer term follow-up is essential to more ade-
4 | DISCUSSION quately assess liver-related reactions, and a larger sample size is needed to
more fully assess adverse events with molnupiravir.
In our series of cats with presumptive FIP treated with an off-label Molnupiravir is active against SARS-CoV-2 and other RNA viruses19
compounded formulation of molnupiravir, 14 out of 18 cats achieved and generates only low-level resistance in a cell culture.20-22 The efficacy
remission and remained in remission at the time of writing, during up of oral administration of molnupiravir was evaluated in a phase 3, random-
to 107 days of follow-up. Four cats showed signs of potential hepatic ized control trial in 1433 people with COVID-19, with a lower percentage
adverse events; 3 cats developed ALT activity above the reference of hospitalizations or deaths by Day 29 in the molnupiravir group com-
range during the first 7 to 9 days of treatment, all of which resolved pared with placebo.18 Another important clinical question is whether
without management, and 1 developed jaundice on Day 37, which molnupiravir-resistant viruses might be generated, and how many cats
required inpatient treatment. experience relapse or reinfection after treatment.
The approved human molnupiravir formulation is 200 mg in cap- All owners who provided informed consent to this study were
sule form, but must be divided into smaller dosage components for included in the order of participation, so there should be little risk of
animals to facilitate an appropriate dose by body weight. We chose to any bias. Nevertheless, selection bias should be considered as this
compound molnupiravir as small tablets to simplify administration. case series was enrolled at a single center in Chiba prefecture, Japan.
We speculated that cats might refuse to swallow the drug as a pow- Another potential limitation of our case series is that the diagnosis of
der or in a water solution and owners might find it difficult to adminis- FIP was presumptive in all cases. Cats might have FCoV viremia with-
ter the entire dose in powder form every time. out FIP, so RT-PCR detection of FCoV RNA is not specific for FIP,7
The minimum effective dose of molnupiravir for FIP is recom- although this technique has high sensitivity (90%) and specificity
mended to be 4.5 mg/kg PO every 12 hours for cats without (96%) for FIP when applied to FNA samples.23 In our series, the
 19391676, 2023, 5, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jvim.16832 by Nat Prov Indonesia, Wiley Online Library on [28/11/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
1880 SASE

combination of RT-PCR with clinical signs, and other serum biochem- 8. Pedersen NC. Fifty years' fascination with FIP culminates in a promis-
istry including low A/G ratio were highly suggestive of FIP.7 This case ing new antiviral. J Feline Med Surg. 2019;21:269-270.
9. Murphy BG, Perron M, Murakami E, et al. The nucleoside analog
series suggests that molnupiravir might be an effective and
GS-441524 strongly inhibits feline infectious peritonitis (FIP) virus in
well-tolerated treatment for FIP. tissue culture and experimental cat infection studies. Vet Microbiol.
2018;219:226-233.
ACKNOWLEDGMENT 10. Pedersen NC, Perron M, Bannasch M, et al. Efficacy and safety of the
nucleoside analog GS-441524 for treatment of cats with naturally occur-
The writing was supported by Yoshiko Okamoto, PhD, CMPP. English
ring feline infectious peritonitis. J Feline Med Surg. 2019;21:271-281.
editing was supported by Catherine Rees and Jordana Campbell. 11. Jones S, Novicoff W, Nadeau J, Evans S. Unlicensed GS-441524-like
Medical writing was financially supported by Koichi Takeuchi, Yuki antiviral therapy can be effective for at-home treatment of feline
Takazawa, Nanae Karasawa, Koichiro Ando, Fumi Sugita through Tiger infectious peritonitis. Animals (Basel). 2021;11:2257.
12. Krentz D, Zenger K, Alberer M, et al. Curing cats with feline infectious
Funding hosted by Yoshiaki Iwai.
peritonitis with an oral multi-component drug containing GS-441524.
Viruses. 2021;13:2228.
DATA AVAI LAB ILITY S TATEMENT 13. Katayama M, Uemura Y. Therapeutic effects of Mutian
The data presented in this study have not been published elsewhere ([R]) Xraphconn on 141 client-owned cats with feline infectious peri-
tonitis predicted by total bilirubin levels. Vet Sci. 2021;8:328.
but are available on request from the corresponding author.
14. Katayama M, Uemura Y. Prognostic prediction for therapeutic effects of
Mutian on 324 client-owned cats with feline infectious peritonitis based
CONF LICT OF IN TE RE ST DEC LARAT ION on clinical laboratory indicators and physical signs. Vet Sci. 2023;10:136.
The author declares no conflict of interest. 15. Roy M, Jacque N, Novicoff W, Li E, Negash R, Evans SJM. Unlicensed
molnupiravir is an effective rescue treatment following failure of unli-
censed GS-441524-like therapy for cats with suspected feline infec-
OFF- LABE L ANT IMICR OBIAL DE CLARAT ION
tious peritonitis. Pathogens. 2022;11:1209.
Experimental use of molnupiravir was approved by the Institutional 16. FIP Warriors CZ/SK. EIDD-2801 (Molnupiravir). Czech Republic: FIP
Review Board of the You-Me Clinic. Warriors CZ-SK; 2021 [cited June 30, 2022]. https://www.
fipwarriors.eu/en/eidd-2801-molnupiravir/.
17. Pedersen NC. The Long History of Beta-d-N4-Hydroxycytidine and Its
INS TITUTIONAL ANIMAL CARE AND U SE C OMMITTEE
Modern Application to Treatment of Covid-19 in People and FIP in Cats.
(IACUC) OR OTHER APPROVAL DECLARAT ION Davis, CA: UC Davis Veterinary Medicine; 2021 [cited October
Informed Consent was obtained from all cat owners included in this 25, 2022]. https://ccah.vetmed.ucdavis.edu/sites/g/files/dgvnsk4
study. 586/files/inline-files/The%20long%20history%20of%20beta-d-N4-h
ydroxycytidine%20and%20its%20modern%20application%20to%20
treatment%20of%20Covid-19%20in%20people%20and%20FIP%20
HUMAN ETHICS APPROVAL DECLARATION in%20cats.pdf.
The author declares human ethics approval was not needed for this 18. Jayk Bernal A, Gomes da Silva MM, Musungaie DB, et al. Molnupira-
study. vir for oral treatment of Covid-19 in nonhospitalized patients. N Engl
J Med. 2022;386:509-520.
19. Yip AJW, Low ZY, Chow VTK, Lal SK. Repurposing molnupiravir for
ORCID COVID-19: the mechanisms of antiviral activity. Viruses. 2022;14:1345.
Okihiro Sase https://orcid.org/0000-0002-8849-7044 20. Agostini ML, Pruijssers AJ, Chappell JD, et al. Small-molecule antiviral
β-d-N (4)-hydroxycytidine inhibits a proofreading-intact coronavirus
with a high genetic barrier to resistance. J Virol. 2019;93:e01348.
RE FE R ENC E S 21. Cox RM, Wolf JD, Plemper RK. Therapeutically administered ribonu-
1. Addie D, Belák S, Boucraut-Baralon C, et al. Feline infectious peritoni- cleoside analogue MK-4482/EIDD-2801 blocks SARS-CoV-2 trans-
tis. ABCD guidelines on prevention and management. J Feline Med mission in ferrets. Nat Microbiol. 2021;6:11-18.
Surg. 2009;11:594-604. 22. Wahl A, Gralinski LE, Johnson CE, et al. SARS-CoV-2 infection is
2. Felten S, Hartmann K. Diagnosis of feline infectious peritonitis: a effectively treated and prevented by EIDD-2801. Nature. 2021;591:
review of the current literature. Viruses. 2019;11:1068. 451-457.
3. Wang YT, Su BL, Hsieh LE, Chueh LL. An outbreak of feline infectious 23. Dunbar D, Kwok W, Graham E, et al. Diagnosis of non-effusive feline
peritonitis in a Taiwanese shelter: epidemiologic and molecular evi- infectious peritonitis by reverse transcriptase quantitative PCR from
dence for horizontal transmission of a novel type II feline coronavirus. mesenteric lymph node fine-needle aspirates. J Feline Med Surg. 2019;
Vet Res. 2013;44:57. 21:910-921.
4. Addie DD, Toth S, Murray GD, Jarrett O. Risk of feline infectious peri-
tonitis in cats naturally infected with feline coronavirus. Am J Vet Res. SUPPORTING INF ORMATION
1995;56:429-434.
Additional supporting information can be found online in the Support-
5. Foley JE, Poland A, Carlson J, Pedersen NC. Risk factors for feline infec-
tious peritonitis among cats in multiple-cat environments with endemic ing Information section at the end of this article.
feline enteric coronavirus. J Am Vet Med Assoc. 1997;210:1313-1318.
6. Pedersen NC. A review of feline infectious peritonitis virus infection:
1963-2008. J Feline Med Surg. 2009;11:225-258. How to cite this article: Sase O. Molnupiravir treatment of 18
7. Thayer V, Gogolski S, Felten S, Hartmann K, Kennedy M, Olah GA. cats with feline infectious peritonitis: A case series. J Vet Intern
2022 AAFP/EveryCat feline infectious peritonitis diagnosis guide- Med. 2023;37(5):1876‐1880. doi:10.1111/jvim.16832
lines. J Feline Med Surg. 2022;24:905-933.