Michele Rosenbaum, VMD, DACVD

Targeted Treatments for Canine Patients With Allergic Skin Disease

The key to successfully getting your patients and their owners off the itchy dog roller coaster is getting patients on a treatment path that provides fast, effective, and safe itch relief. Once the pet and their owner get relief, the owner is more likely to pursue a diagnostic workup to find the all-important cause of the pet’s itch.

Pet owners are looking for innovative therapies that are effective and work fast. Antihistamines are not effective for treating allergic itch in most dogs.^1-3 The International Committee on Allergic Diseases of Animals (ICADA) in an evidence-based review put antihistamines in the group of drugs likely to be of little or no benefit for acute flares of allergic dermatitis.³ The same review supports oral steroids as likely to improve clinical signs of dogs with severe or extensive atopic dermatitis.³

Two targeted options to help manage allergic skin disease are Apoquel^® (oclacitinib tablet) and Cytopoint^®. Apoquel is recommended in the ICADA review for treatment of acute flares of allergic dermatitis, as well as chronic treatment of allergic dermatitis.³ Cytopoint was not available at the time of this 2015 review. These treatments target specific cytokines important in the allergic itch cycle. Efficacy and safety for both Apoquel and Cytopoint have been demonstrated.^4-10 Apoquel is a Janus Kinase inhibitor (JAKi) that works by inhibiting the function of cytokines that drive allergic inflammation and pruritus.¹¹ Apoquel reduced allergic itch and dermatitis as effectively as steroids in an Australian head-to-head clinical study.⁶ It is given as an oral tablet and controls itch and inflammation in dogs with allergic and atopic dermatitis. Apoquel has a rapid onset of efficacy starting within 4 hours,⁶ controls itch in 24 hours,⁴ and is out of the system in 24 hours or less.¹² This makes it ideal as a first-line treatment to get the itch under control quickly, to stop and start itch control during the diagnostic workup, and for summer itch flares. The most common side effects of Apoquel in short-term studies were vomiting and diarrhea.⁴

Cytopoint is a caninized monoclonal antibody that targets canine IL-31, a cytokine important in sending the itch signal to the brain.¹⁰ It is given as an in-office subcutaneous injection, and is effective for the treatment of dogs against allergic dermatitis and atopic dermatitis.^10-12 Cytopoint begins to relieve itch within 24 hours and lasts for 4 to 8 weeks, giving the skin time to heal.¹⁰ The most common side effects of Cytopoint were mild, self-limiting vomiting, diarrhea, and lethargy.⁸

Choosing the best allergic dermatitis treatment to help reduce anxiety and stress for your patients and pet parents

Work with your pet parents to help them decide which therapy is best for their pet’s and their own needs and lifestyle. For those patients who are anxious or fearful of injections, travel, or visits to the veterinary clinic, Apoquel given at home may be the best option because it is an oral medication. To give oral medications to pets, have owners condition them to take a small treat first, then a second treat hiding the Apoquel, finally receiving a third treat as a reward.

You may be able to further reduce your patient’s and pet parent’s anxiety and stress by giving a Cytopoint injection in the office to avoid problems around medication time. Cytopoint is an excellent choice of therapy to reduce the burden of care for busy owners, difficult-to-pill dogs, dogs with serious infections, and patients under 12 months old with early onset allergy. When owners are anxious and distressed about the many treatments required to manage their pet’s chronic disease (like allergic dermatitis), this results in more phone calls and e-mails to the veterinarian, increasing stress in the practice.¹³

A recent multi-center study of 68 dogs with atopic dermatitis showed that as soon as day seven, dogs’ itch scores decreased by 57 percent. This decrease in their pet’s itch score was directly correlated with owner quality of life scores that more than doubled within seven days, showing how owners’ lives are better when their pets are less itchy, especially if this treatment does not increase owner burden of care.¹⁴

In the exam room, have technicians use a distraction technique by giving the dog a treat before the injection, while the pet receives the Cytopoint injection, and after the injection as a reward.

Owners can use an Itch Tracker at home to monitor their pet’s response to treatment.

When treating the itchy allergic dog, always provide itch relief first to help reduce anxiety and stress for the pet and their owner and to maintain their special bond. Choose the treatment that best fits the pet owner and dog’s preferences and lifestyle. The goal is for all our allergic patients to have a fun and itch-free summer. August is Itchy Pet Awareness Month! Find tools to get your practice team excited and prepared on www.itchypetawarenessmonth.com.

Next: Identifying the all-important cause of the patient’s itch with a stepwise diagnostic workup in Part 4.

Cytopoint^® Indications: Cytopoint has been shown to be effective for the treatment of dogs against allergic dermatitis and atopic dermatitis.

Apoquel^® Important Safety Information: Do not use Apoquel in dogs less than 12 months of age or those with serious infections. Apoquel may increase the chances of developing serious infections, and may cause existing parasitic skin infestations or pre-existing cancers to get worse. Consider the risks and benefits of treatment in dogs with a history of recurrence of these conditions.  New neoplastic conditions (benign and malignant) were observed in clinical studies and post-approval.  Apoquel has not been tested in dogs receiving some medications including some commonly used to treat skin conditions such as corticosteroids and cyclosporines. Do not use in breeding, pregnant, or lactating dogs. Most common side effects are vomiting and diarrhea. Apoquel has been used safely with many common medications including parasiticides, antibiotics and vaccines.  For more information, please see the full Prescribing Information at

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

References

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    3. Olivry T, et al; International Committee on Allergic Diseases of Animals. Treatment of canine atopic dermatitis: 2015 updated guidelines from the International Committee on Allergic Diseases of Animals (ICADA). BMC Vet Res. 2015 Aug 16; 11:210.
    4. Cosgrove SB, et al. Efficacy and safety of oclacitinib for the control of pruritus and associated skin lesions in dogs with canine allergic dermatitis. Vet Dermatol. 2013 Oct;24(5):479-e114.
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    7. Cosgrove SB, et al. A blinded, randomized, placebo-controlled trial of the efficacy and safety of the Janus kinase inhibitor oclacitinib (APOQUEL^®) in client-owned dogs with atopic dermatitis. Vet Dermatol. 2013 Dec;24(6):587-9
    8. Michels GM, et al. A blinded, randomized, placebo-controlled, dose determination trial of lokivetmab (ZTS-00103289), a caninized, anti-canine IL-31 monoclonal antibody in client-owned dogs with atopic dermatitis. Vet Dermatol. 2016;27:478-e129.
    9. Michels GM, et al. A blinded, randomized, placebo-controlled trial of the safety of lokivetmab (ZTS-00103289), a caninized anti-canine IL-31 monoclonal antibody in client-owned dogs with atopic dermatitis. Vet Dermatol. 2016 Dec;27(6):505-e13
    10. Souza CP, et al. A retrospective analysis of the use of lokivetmab in the management of allergic pruritus in a referral population of 135 dogs in the western USA. Vet Dermatol. 2018;29:489-e164.
    11. Gonzales AJ, et al. Oclacitinib (APOQUEL^®) is a novel Janus kinase inhibitor with activity against cytokines involved in allergy. J Vet Pharmacol Ther. Aug 2014;37(4):317–324.
    12. Collard WT, et al. The pharmacokinetics of oclacitinib maleate, a Janus kinase inhibitor, in the dog. J Vet Pharmacol Ther. 2014 Jun;37(3):279-85.
    13. Spitznagel MB et al. Assessment of caregiver burden and associations with psychosocial function, veterinary service use, and factors related to treatment plan adherence among owners of dogs and cats. JAVMA 2019;254(1):124-132.
    14. Data on file. Study Report 17SORDER-01-01, Zoetis Inc.