What Primary Care Data Reveals About Protein-Losing Enteropathy in Pugs

Protein-losing enteropathy (PLE) is a serious and often life-threatening condition in dogs, and brachycephalic breeds, especially Pugs, appear to be at increased risk. A newly published study using VetCompass primary care veterinary data sheds light on how PLE is managed in everyday practice and which treatments may influence outcomes.

Study Overview

Researchers analyzed primary care veterinary records from the UK to evaluate the clinical management and outcomes of 51 Pugs diagnosed with PLE between 2017 and 2024. The goal was to describe real-world diagnostic findings, treatments, referral patterns, and survival and to determine whether referral or specific therapies were associated with improved outcomes.

Key Findings at a Glance

• Referral wasn’t universal:
  Only 41% of Pugs with PLE were referred for specialty care, meaning most cases were managed entirely in primary care settings.

• High mortality rate:
  Nearly 43% of Pugs died due to PLE, with over half of deaths occurring within the first 3 months after diagnosis — highlighting how aggressive this disease can be early on.

• Common treatments used in practice:

  • Prednisolone: 67%

  • Chlorambucil: 12%

  • Cyclosporin: 4%

  • Clopidogrel: 28%

Treatments Linked to Better Short-Term Survival

Two medications stood out when researchers compared dogs alive at 3 months versus those that died early:

• Prednisolone:
  Pugs that survived beyond 3 months were significantly more likely to have been treated with prednisolone.

• Clopidogrel:
  Notably, none of the dogs that died within 3 months had received clopidogrel, while a substantial portion of survivors had.

These findings suggest that anti-inflammatory therapy and antithrombotic management may play an important role in short-term survival for Pugs with PLE — particularly given the known risk of thromboembolic complications in these patients.

Does Referral Improve Outcomes?

Interestingly, referral status did not significantly affect survival at:

• 3 months

• 1 year

• 2 years

Pugs managed in primary care had similar survival outcomes to those referred though the authors caution that disease severity could not be fully assessed using retrospective data.

What This Means for Veterinarians

This study highlights several important takeaways for clinicians:

• PLE in Pugs carries a guarded to poor prognosis, especially in the early months following diagnosis.

• Primary care veterinarians are managing many of these cases, often without referral.

• Prednisolone and clopidogrel may improve short-term survival, but causation cannot be confirmed.

• Referral alone may not guarantee better outcomes, underscoring the need to individualize care based on disease severity, client goals, and access.

The Bottom Line

Real-world data from VetCompass shows that PLE in Pugs is frequently fatal, but early medical management, particularly with prednisolone and clopidogrel — may improve short-term survival. More prospective, severity-adjusted studies are needed to determine optimal treatment strategies and clarify which dogs benefit most from referral versus primary care management.

For now, early recognition, aggressive medical therapy, and clear client communication remain key.