Atopica v Apoquel/cytopoint

RE: Atopica v Apoquel/cytopoint

Anthony Todd — Thu, 14 May 2020 09:28:28 GMT

[quote userid="5407" url="~/001/veterinary-clinical/small-animal/dermatology/f/discussions/29096/atopica-v-apoquel-cytopoint/222563"]steroids are bad[/quote]

Perhaps "steroids are bad" because the dose of, say, pred is given daily when it's effect and blood levels probably last 5 days or so.

Thus daily dosage actually means the blood levels will rise day by day, as the residual drug is added each day to the new dose.

This may be why the drug is blamed and/or has side effects like diabetes and polydipsia ?

Intermittent dosage every 5 days, or when necessary, avoids this, and injectables have a falling blood level from the start.

In addition it means that, if the allergen exposure is intermittent dosage can be stopped if the reaction does and identification maybe discovered.

RE: Atopica v Apoquel/cytopoint

Mark Craig — Thu, 14 May 2020 09:09:16 GMT

I was never a bit Atopica fan, even before the arrival of Cytopoint and Apoquel. Steroids are cheap and, in my experience, generally work much better than Atopica. In dogs where steroids do not work well or are poorly tolerated, I have rarely seen Atopica work better or even as well. Atopica was often prescribed by vets because owners had concerns regarding steroid use. Perfectly valid concers, of course, but many owners see the issue as black and white: steroids are bad, everything else is good. If only life were that simple. I used to see dogs referred to me on both steroids and Atopica, just as now I see them on both steroids and Apoquel! I think Apoquel and Cytopoint are both very good products. Many people, however, forget that Apoquel is contraindicated in dogs under a year or 3 kg in weight, in immune suppressed dogs and those with evidence of progressive malignant neoplasia.

RE: Atopica v Apoquel/cytopoint

David Scarff — Thu, 14 May 2020 08:05:53 GMT

Whilst I would agree that vaccination often works when data sheets suggest otherwise, there is individual variation, and to ignore the data sheet and therefore effectively go off label would open us to problems if problems occur. The only killed vaccines we use are those for Leptospirosis.

RE: Atopica v Apoquel/cytopoint

Michael Woodhouse — Wed, 13 May 2020 23:20:57 GMT

[quote userid="2116" url="~/001/veterinary-clinical/small-animal/dermatology/f/discussions/29096/atopica-v-apoquel-cytopoint/222552"]One of the problems with cyclosporine is the need to stop it for two weeks before and two weeks after vaccination, and it can then take several weeks to regain control.[/quote]

I'm not sure 'NEED' is the right word to be choosing. Yes the data sheet says no with live vaccines and that makes perfect sense:

"Particular attention must be paid to vaccination. Treatment with the veterinary medicinal product may interfere with vaccination efficacy. In the case of inactivated vaccines, it is not recommended to vaccinate during treatment or within a two-week interval before or after administration of the product."

Evidence out there in the human literature that vaccination is fine when on cyclosporin.

https://www.ncbi.nlm.nih.gov/pubmed/26354557

Evidence in cats that they don't respond to primary vaccinations, but do respond to boosters when under treatment

https://www.ncbi.nlm.nih.gov/pubmed/24820998

I've always taken a very pragmatic view to vaccination of dogs on cyclosporin and carried on regardless (with killed vaccines) with the view that immunosuppression may make them more susceptible to preventable infectious disease. Strikes me as madness to destabilise the dog and withhold treatment in these situations. Whilst drugs like this (and I treat prednisolone in a similar way) do suppress the immune system - they do not obliterate it. The animal still has a functioning immune system - or it would be dead.

Back O/T - If the owner can afford it then I'd start on Apoquel and move to Cytopoint if stable and effective. If not efficacious then cyclosporin (Atopica). If no money then lowest effective dose of preds. If I can control itch without suppressing the immune system I will. Like the fact I can use Apoquel for short courses on temporary itchiness. I still often reach for a shot of dex out of old habits.

RE: Atopica v Apoquel/cytopoint

David Scarff — Wed, 13 May 2020 20:27:10 GMT

One of the problems with cyclosporine is the need to stop it for two weeks before and two weeks after vaccination, and it can then take several weeks to regain control.

RE: Atopica v Apoquel/cytopoint

David Bentley — Wed, 13 May 2020 19:02:08 GMT

Atopica still has its place. It certainly is better at controlling inflammation in atopic otitis than Apoquel and Cytopoint. Cytopoint is purely anti-Interleukin 31 and therefore just anti iitch. Apoquel does have some mildly immunosuppressive activity due to being a JAK inhibitor but is still fairly ineffective at treating the inflammation, particularly chronic inflammation, in ears where there are several other mediators involved ( steroids still necessary with these and Atopica can also help)

One thing in Atopica’s favour is that some lucky individuals can manage on less than once daily treatment and I remember a particularly nasty case of atopic dermatitis in an English Bulldog that was kept under control on just one dose every 4 days. These cases will be cheaper to control than daily Apoquel, which due to its short half life is out of the system within 19 hours of a tablet being given.

Cytopoint is good...I have about 8 cases now which only need the injection every 3months.

RE: Atopica v Apoquel/cytopoint

Allison Gleadhill — Wed, 13 May 2020 18:59:31 GMT

Cytopoint is expensive & I am using it much more in the terrier sized dogs in some it has been an absolute game changer for a dog & owners qol & owners have been so happy with it that they have been desperate to have it given during lockdown. Generally once I am happy with how the dog is doing it is been given by a nurse most of the time.

RE: Atopica v Apoquel/cytopoint

Beats — Wed, 13 May 2020 18:16:19 GMT

apoquel and cytpoint are more anti-itch than anti-inflammatory. That generally works well as presumably most skin lesions are a result of itch. The most obvious place where it doesn't work well is down ear canals where the inflammation is generally not a result of pruritus. Thus fine to use, but probably couple with some steroids down ears couple of times a week for maintenance.

Atopica (or any other oral ciclosporin) is anti-inflammatory, so will help with ears directly. Whether it has less side effects or not than steroids (the other obvious choice for atopy) I think is a good question. I remember hearing Danny Scott saying he hadn't used it IIRC just a few years back, so if you're not a fan then you're in good company!

Personally, I must say I like cytopoint. I am look-warm on apoquel. I have limited experience with cytopoint, but if is was £1 a shot I would be using a lot of it personally.