Apoquel - Long term use and blood sampling

RE: Apoquel - Long term use and blood sampling

Neil Wheadon — Thu, 02 Feb 2017 10:56:06 GMT

Personally, and I am influenced by these discussions I can see the reason for doing a baseline on longstanding medication as 'you don't know where you are going unless you know where you've been' After all these dogs will be on long term medication and to me it's quite an easy sell to clients, especially when the basic non interpreted samples at external labs are quite cheap (£30 at the place I'm at)

Maybe Zoetis should look to get these results and do some monitoring in the field as all we have at the moment is a forum such as this to share this information

Neil

RE: Apoquel - Long term use and blood sampling

Bob Russell — Thu, 02 Feb 2017 09:43:08 GMT

If I remember right the data sheet does list vomiting on Apoquel v's Placebo and not much difference between groups! Will look later!

May be coincidence as I have not had anyone report this and I too use Apoquel quite a lot and have done since it was introduced.

Have rechecked data sheet - 3.9% vomited on Apoquel 4.1% placebo!

Non-progressive decrease in leukocyte count but still within lab ref numbers. Increase in cholesterol.

Not really going to bite on the pred front but compare that to the change in blood count on corticosteroids.

Some dogs do better on prednisolone but I have had patients return to 'normal' skin on Apoquel that had never been comfortable on preds.

I tell owners that there is 5 or more years of safety data on Apoquel and after that they might grow a second head and start to talk French but probably won't!

Improvement in quality of life outweighs pretty much every other factor IMO.

RE: Apoquel - Long term use and blood sampling

Julie Innes — Thu, 02 Feb 2017 09:25:15 GMT

I've had a fairly good response to apoquel, and not seen too many side effects at all- a couple of dogs vomited on it. I hadn't been doing routine bloods, maybe I should be, but as a pp said owners are often already moaning about costs, and see blood testing when the dog seems fine as us "out to make money". I will advise them it can be done. I usually do it with long term NSAIDs, mainly to check renal function. Is there something specific we should be looking out for with apoquel, or is it just general screening?

RE: Apoquel - Long term use and blood sampling

Braden Collins — Thu, 02 Feb 2017 01:42:00 GMT

Apoquel has been available in Australia for less than 12 months now, so we haven't hit the point of blood tests yet. I'm not really sure what we would be looking for in terms of Apoquel causing problems.

For long term pred, I tend to use blood tests more for a baseline - if the dog becomes unwell, it's useful to know its baseline liver enzymes when on pred so you have a rough idea as to whether the changes are likely significant.

I have been using Apoquel on my own dog who has a seasonal allergy. It worked amazingly well. I started on the BID dosing and dropped to SID after a few days (due to poor owner compliance rather than a planned reduction) and it still seemed to be effective. When I ran out and missed a few days he started scratching again so started on SID dosing again and it seemed to control things quickly.

We have found the uptake of Apoquel excellent - a lot of previous pred users have come in for more pred with no previous reports of issues with it, but when told there is an alternative they will often say the dog had some issues with pred. Despite telling them that pred is still fine if the dog copes well with it, and Apoquel being multiple times the price, I find most people are keen to change to Apoquel and the response has been very positive. Of course, this may just be people wanting the new fangled drug, but I think most feel that pred was causing some issues, especially behavioural changes.

RE: Apoquel - Long term use and blood sampling

Robin Grimmer — Wed, 01 Feb 2017 23:55:19 GMT

What's the point in blood testing an animal on steroids? Given the changes on haematology and biochemistry are typical and well documented what useful information will it give you?

RE: Apoquel - Long term use and blood sampling

Laurence Webb — Wed, 01 Feb 2017 23:22:39 GMT

To get back to Neil's question, I discuss it with the owner and we decide what to do. Interestingly I find a much higher uptake for routine blood sampling with Apoquel users than steroid users.

This may be historical - times change and advice changes. 10 years ago we may have been happy checking a patient on preds periorically and advising a blood sample (normally refused). Client demographic must also be a factor.

When I start a patient on Apoquel I tell them that we don't know what the long term side effects are so that we advise blood sampling regularly. Most of them are happy to have bloods done every 6-12 months and I suggest about 3 months after starting treatment as well.

It is a little strange, as there are know side effects with steroids but Apoquel side effects are unknown.

So far I haven't seen any biochemical or haematological changes so I wonder if this is something that will remain in the data sheet as time goes on.

PS Antony, we use both to the minimum effective dose.

RE: Apoquel - Long term use and blood sampling

Anthony Todd — Wed, 01 Feb 2017 23:18:04 GMT

[quote user="Neil Wheadon"]Maybe troll is to strong a word, you're not a troll but dogmatic without the benefit of seeing veterinary medicine in a modern setting as you are retired, that's a fact. [/quote]

Difficult not to be described as "dogmatic" when a "modern" drug is hailed as the bees-knees, but with more side effects and other disadvantages than a "retired" drug, which can be denigrated only by quoting it's gross misuse.

RE: Apoquel - Long term use and blood sampling

Neil Wheadon — Wed, 01 Feb 2017 23:13:22 GMT

I missed this one

[quote user="Anthony Todd"]I guess I saw more itchy dogs in a week than modvets see in a month or more.[/quote]

How do you know that? Have you done a full surgery this week?

I see as many today as I saw 26 years ago. In fact I see more as rather than resect a lateral wall of an ear canal, I recognise the allergic component.

You've asked before, to know why you get the red stars and this is why, and I'm trying to tell you, statements such as this are ..........

Neil

RE: Apoquel - Long term use and blood sampling

Neil Wheadon — Wed, 01 Feb 2017 22:55:54 GMT

Hi Anthony

Maybe troll is to strong a word, you're not a troll but dogmatic without the benefit of seeing veterinary medicine in a modern setting as you are retired, that's a fact. You may wish to stay in touch and voice your opinion but much like Bovine Tb to which I was an 'expert' 5 years ago, time dims, things move on and I no longer feel that I can comment in ways that I could, aside from my dogma and rose tinted glasses, that's what time does.

For the last time

[quote user="Anthony Todd"]I never saw the exaggerated side effects[/quote]

so you saw some

[quote user="Anthony Todd"]In my hands I never saw the exaggerated side effects, that modvets describe[/quote]

Well I have, maybe you just got lucky, maybe dogs these days are smaller, maybe there are more allergic dogs than 20 years ago.

But crucially read the title 'Apoquel - Long term use and blood sampling

I feel that as with ears, skins etc etc this query has been hijacked again by an argument on preds and that's unhealthy to debate as it feels like Groundhog Day and we all lose interest very very quickly.

'You learn nothing by listening to yourself'

Neil

RE: Apoquel - Long term use and blood sampling

Anthony Todd — Wed, 01 Feb 2017 22:41:41 GMT

Please advise me then, instead of just dismissing me as a troll.

I guess I saw more itchy dogs in a week than modvets see in a month or more.

I seemed to control their itch without harm to the animal and nearly always got them of the steroids 'cos control of fleas and removal of other allergens finally got through to most owners if you explain it often enough.

In my hands I never saw the exaggerated side effects, that modvets describe, 'cos I used the drugs sensibly, and to effect rather than to a dose-rate.

Now a new wonder drug is marketed, with apparently, and according to the manufacturer, potentially major side effects, additionally needing continuous administration, and at much greater cost.

Yet, I am a troll......

Tell me where I am wrong, give me actual evidence of which you all are supposed to be so dedicated to follow, rather than the usual unsubstantiated examples of gross misuse of a valuable, effective, drug.

RE: Apoquel - Long term use and blood sampling

Gillian Mostyn — Wed, 01 Feb 2017 21:54:15 GMT

Just realised I didn't actually answer your question Neil- sorry!

We've a few cases on long term apoquel and, in general, they do very well and I'm not aware of any serious side effects. I must admit I didn't even see that you're supposed to check their bloods periodically - oops. Will bear that in mind now though.

RE: Apoquel - Long term use and blood sampling

Neil Wheadon — Wed, 01 Feb 2017 20:57:51 GMT

I start posts for a variety of reasons

1) Brexit, to be a little contentious, it colours the day.

2) To ask something that I feel is of interest, maybe something common that brings out something

3) Something I don't know and am interested in opinion.

In the latter 2 cases, I feel I started them so maybe I'm entitled to try to steer a little, so for the last time this is about Apoquel, I don't give a monkeys about preds, that wasn't the question and I simply don't want that dragged in ....again. Last warning, because all it does is turn people off and Gillian has reached that point. Either that or I will start to tangent with a troll sign and I mean it.

Neil

RE: Apoquel - Long term use and blood sampling

Alastair Welch — Wed, 01 Feb 2017 20:41:13 GMT

Gillian stop feeding the trolls.

RE: Apoquel - Long term use and blood sampling

Gillian Mostyn — Wed, 01 Feb 2017 19:55:47 GMT

[quote user="Anthony Todd"]Oh come on "constantly" gimme a break![/quote]

This will be my last comment on the matter - don't expect any replies Anthony.

Yes, constantly. I use minimum effective doses and pulse therapy as appropriate. I know that some dogs need to have corticosteroids - same as some people do. Costs also play a part. But corticosteroids have side effects. Appropriate dosing regimes minimise them and, in some dogs, are deemed to be at an acceptable level to justify continued use.

Just because some dogs do very well for many years on prednisolone and for some pets it is an entirely appropriate therapy does not blind me to the fact that there are side effects.

[quote user="Anthony Todd"]Give me a few screen grabs from your notes, with dates.[/quote]

You cheeky sod! No, I don't need your second opinion thanks.

I'm done.

RE: Apoquel - Long term use and blood sampling

Anthony Todd — Wed, 01 Feb 2017 19:39:55 GMT

that's why discussion of the use of preds is pointless. You never once saw the side effects that the rest of us see constantly.

Oh come on "constantly" gimme a break!

Give me a few screen grabs from your notes, with dates.

RE: Apoquel - Long term use and blood sampling

Gillian Mostyn — Wed, 01 Feb 2017 19:29:10 GMT

[quote user="Anthony Todd"]You better start communicating with your colleagues![/quote]

Oh, the irony.

RE: Apoquel - Long term use and blood sampling

Anthony Todd — Wed, 01 Feb 2017 19:07:32 GMT

Baloney, if the dosage is managed.

[quote user="Robin Grimmer"]Whereas with Apoquel, we are talking about possible side effects that are pretty rare.[/quote]

Well I do hope you are informing, and with consent, your clients.

This is from the manufacturers site [via NOAH]

Clinical observations that were considered likely to be related to oclacitinib treatment included: alopecia (local), papilloma, dermatitis, erythema, abrasions and scabbing/crusts, interdigital "cysts", and oedema of the paws. Dermatitis lesions were mostly secondary to the development of interdigital furunculosis on one or more paws during the study; the number and frequency of observations increased with increasing dose. Lymphadenopathy of peripheral nodes was noted in all groups and increased in frequency with increasing dose, and was frequently associated with interdigital furunculosis. Papilloma was considered treatment related, but not dose related.

Makes pred look like a bowl of cold water....

RE: Apoquel - Long term use and blood sampling

Anthony Todd — Wed, 01 Feb 2017 18:59:07 GMT

[quote user="Robin Grimmer"]This. This will happen with all cases on long term preds to some extent. Whereas with Apoquel, we are talking about possible side effects that are pretty rare.[/quote]

Never ever happened with my cases on long term pred.'cos I used it sensibly, as necessary at in minimum effective doses.

RE: Apoquel - Long term use and blood sampling

Anthony Todd — Wed, 01 Feb 2017 18:55:03 GMT

[quote user="Gillian Mostyn"]That's why discussion of the use of preds is pointless. You never once saw the side effects that the rest of us see constantly. [/quote]

So you've all been misusing the drug, and constantly. I thought modvets were better than that.

I've seen it, but never in my hands, and not in my practice, at least not more than once.

You better start communicating with your colleagues!

RE: Apoquel - Long term use and blood sampling

Robin Grimmer — Wed, 01 Feb 2017 18:31:04 GMT

[quote user="janine redman"]

Have a few patients that have developed proliferation of gingiva

[/quote]

Seen that with Atopica too. How does Atopica stack against Apoquel? Cost, efficacy, side effects?

RE: Apoquel - Long term use and blood sampling

janine redman — Wed, 01 Feb 2017 18:20:40 GMT

Have a few patients that have developed proliferation of gingiva , or multiple warts. Zoetis says not dose dependant but is a drug reaction so need to do a risk benefit analysis as to which the client would prefer. Lumps or not itchy

RE: Apoquel - Long term use and blood sampling

Robin Grimmer — Wed, 01 Feb 2017 18:14:50 GMT

[quote user="Richard Carter"]

[/quote]

This. This will happen with all cases on long term preds to some extent. Whereas with Apoquel, we are talking about possible side effects that are pretty rare.

RE: Apoquel - Long term use and blood sampling

Gillian Mostyn — Wed, 01 Feb 2017 18:14:39 GMT

That's why discussion of the use of preds is pointless. You never once saw the side effects that the rest of us see constantly.

RE: Apoquel - Long term use and blood sampling

Anthony Todd — Wed, 01 Feb 2017 17:13:14 GMT

[quote user="Richard Carter"]because there isn't the iatrogenic HAC - the weight gain, the hair loss, the drinking, the eating, the urinating, the pot belly, the weak limbs which is what you get with true long term atopy cases on preds - and no - you cannot use pulse pred therapy for these cases as you suggest - you miss a treatment (either medication) and they have ripped a hole in themselves by the time you get to see them again.[/quote]

Gee, no wonder pred has such a bad and unjustified reputation when you read stuff like the above which I have never seen except when the drug is grossly misused, which , unfortunately does happen.

I don't think I ever had an atopic dog on continuous pred or any other steroid, ever, certainly not for more than an initial 2 weeks.

[sorry to hijack the thread, without trying to]

RE: Apoquel - Long term use and blood sampling

Richard Carter — Wed, 01 Feb 2017 16:58:14 GMT

because there isn't the iatrogenic HAC - the weight gain, the hair loss, the drinking, the eating, the urinating, the pot belly, the weak limbs which is what you get with true long term atopy cases on preds - and no - you cannot use pulse pred therapy for these cases as you suggest - you miss a treatment (either medication) and they have ripped a hole in themselves by the time you get to see them again.

Apoquel stops the itch, therefore stops the self mutilation, therefore prevents the hot spot etc. The dog is still allergic.