Apoquel

RE: Apoquel

Anthony Todd — Thu, 18 Jun 2020 11:24:03 GMT

[quote userid="10320" url="~/001/veterinary-clinical/small-animal/dermatology/f/discussions/29137/apoquel/223601"]dogs in this age group had severe adverse effects when dosed at 3x and 5x the recommended dose rate. [/quote]

How often does any vet give any drug to any dog at 3x and/or 5X the recommended rate and how often would said vet expect an adverse effect.....

Why not say "it's OK at normal rates? Or "do not exceed the recommended dose rate? [which would apply to most drugs given to anything]

It just seems an odd reason for the contraindication and there may be times when the drug could be beneficial in young animals.

RE: Apoquel

Clive Ansell — Thu, 18 Jun 2020 05:09:05 GMT

[quote userid="10320" url="~/001/veterinary-clinical/small-animal/dermatology/f/discussions/29137/apoquel/223601"]In the trials, dogs in this age group had severe adverse effects when dosed at 3x and 5x the recommended dose rate. Those aren't very big "overdoses" in the grand scheme of things - easy enough for an owner to get wrong by misreading a label. Certainly a much narrower safe range than with other meds. The same concerns weren't seen in the adult subjects. Hence the contraindication for dogs below 12m[/quote]

I am still a little wary of it, certainly cautious about overuse in cases where a diagnosis hasn't been reached.

It hasn't been around all that long. and If it is so unsafe in dogs < 12 months, how can we be sure it is entirely safe over the long term in older animals? do the clinical trails suggest it is, or has the long term work just not been done? Jury is still out in my book.

RE: Apoquel

Lucy Fleming — Wed, 17 Jun 2020 22:12:13 GMT

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/dermatology/f/discussions/29137/apoquel/223286"]Crikey, it takes a lot to offend me, and real experts have tried, but your reply doesn't answer the question at all, nor make much sense to me??[/quote]

Anthony I don't mean to be rude, but how d oes it not answer your question? You asked why it was contraindicated in dogs under 12 months. In the trials, dogs in this age group had severe adverse effects when dosed at 3x and 5x the recommended dose rate. Those aren't very big "overdoses" in the grand scheme of things - easy enough for an owner to get wrong by misreading a label. Certainly a much narrower safe range than with other meds. The same concerns weren't seen in the adult subjects. Hence the contraindication for dogs below 12m

RE: Apoquel

Tom Ward — Wed, 17 Jun 2020 21:01:47 GMT

[quote userid="8958" url="~/001/veterinary-clinical/small-animal/dermatology/f/discussions/29137/apoquel/223237"]

OK this may seem like a basic / daft question but I can never square it

Apoquel works by stopping the itch

Ear disease is an allergic condition in many many cases

So why does apoquel help / get used in ear cases?

Neil

[/quote]

I've never found it hugely cases in those atopics that seem to only develop OE and have always put it down to the reason you posit. I'd be interested to know if there's any more specific data on it!

RE: Apoquel

Anthony Todd — Fri, 05 Jun 2020 13:58:07 GMT

[quote userid="7542" url="~/001/veterinary-clinical/small-animal/dermatology/f/discussions/29137/apoquel/223285"]Not sure how I’ve offended - apologies if so .[/quote]

Crikey, it takes a lot to offend me, and real experts have tried, but your reply doesn't answer the question at all, nor make much sense to me??

and, of course, someone may need to use the drug for some reason in a pup and there may be no decent reason not to?

RE: Apoquel

Vet2Vet — Fri, 05 Jun 2020 12:58:11 GMT

Sorry , just gave brief outline of what’s in the data sheet to answer your question . Not sure how I’ve offended - apologies if so .

RE: Apoquel

Beats — Fri, 05 Jun 2020 11:57:58 GMT

[quote userid="8958" url="~/001/veterinary-clinical/small-animal/dermatology/f/discussions/29137/apoquel/223238"]I have worked in a few practices that blood sample every 6 months, nothing is found[/quote]

That's odd, here they rarely get blood samples, but when they do quite commonly are mildly leukopenic and have high PCV.

RE: Apoquel

Anthony Todd — Fri, 05 Jun 2020 10:38:33 GMT

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/dermatology/f/discussions/29137/apoquel/223243"]Why is apoquel contraindicated under 12 months?[/quote]

And i get a single reply:

[quote userid="7542" url="~/001/veterinary-clinical/small-animal/dermatology/f/discussions/29137/apoquel/223273"]It’s due to overdose studies in these dogs : multiple issues including but not exclusively generalised demodicosis , pneumonia , sepsis and furunculosis . At same time it’s less effective in this age group regarding efficacy z [/quote]

How do I rate this, on any system, without upsetting someone?

RE: Apoquel

Vet2Vet — Thu, 04 Jun 2020 21:55:34 GMT

It’s due to overdose studies in these dogs : multiple issues including but not exclusively generalised demodicosis , pneumonia , sepsis and furunculosis . At same time it’s less effective in this age group regarding efficacy z

RE: Apoquel

Anthony Todd — Wed, 03 Jun 2020 22:31:57 GMT

[quote userid="5407" url="~/001/veterinary-clinical/small-animal/dermatology/f/discussions/29137/apoquel/223233"]I, not uncommonly, see young (under 12 months old) pruritic dogs referred to me on Apoquel.[/quote]

Why is apoquel contraindicated under 12 months?

RE: Apoquel

Vet2Vet — Wed, 03 Jun 2020 20:28:49 GMT

Agree the marketing seems to say if it itches you should try it . In human medicine these drugs are definitely not used as indiscriminately as used in veterinary medicine and are definitely regarded as higher tier prescribing often only in hands of consultant level physicians . At the end of the day , they are immune system “ blockers “ . Do you think in vet science we are a little innocent regarding any side effects beyond those we can read on a blood test ? Does our patients life span insulate is somewhat ?

RE: Apoquel

Neil Wheadon — Wed, 03 Jun 2020 19:35:30 GMT

[quote userid="5012" url="~/001/veterinary-clinical/small-animal/dermatology/f/discussions/29137/apoquel/223236"]I don't think Apoquel has been around long enough yet to know if there are long term side effects. [/quote]

7-8 years?

I have worked in a few practices that blood sample every 6 months, nothing is found

I think it's safe

Neil

RE: Apoquel

Neil Wheadon — Wed, 03 Jun 2020 19:33:49 GMT

OK this may seem like a basic / daft question but I can never square it

Apoquel works by stopping the itch

Ear disease is an allergic condition in many many cases

So why does apoquel help / get used in ear cases?

Neil

RE: Apoquel

Clive Ansell — Wed, 03 Jun 2020 18:05:15 GMT

In general, I think Apoquel, Cytopoint, and previously Atopica are/were overused. I've been in many practices were it seems to be dished out freely in all pruritic dogs, at the first consultation, often in the absence of any working diagnosis, and in many cases without the exclusion of ectoparasites.

They seem to be viewed as wonder drugs, while prednisolone seems to be viewed by newbies as the work of Satan. Although a good drug, I don't think Apoquel has been around long enough yet to know if there are long term side effects.

RE: Apoquel

Mark Craig — Wed, 03 Jun 2020 15:46:26 GMT

I, not uncommonly, see young (under 12 months old) pruritic dogs referred to me on Apoquel. Sometimes, owners of these dogs have discovered that the drug is contra-indicated and are not amused. I think some vets are either unaware of the age contra-indication or forget when prescribing. In clinical trials, pneumonia and demodicosis were seen in 6-month old dogs given high doses (x3 and x5 recommended dose) of oclacitinib. I can think of little justification for using Apoquel in dogs under 12 months.

RE: Apoquel

Clive Ansell — Wed, 03 Jun 2020 13:39:52 GMT

I would echo Judith's excellent post.

There is a direct contraindication to its use, "Do not use in dogs less than 12 months of age or less than 3 kg bodyweight.", so would therefore not use it unless a very pressing clinical reason too.

I would want a diagnosis in such a young dog. If I wanted an immediate anti pruritic drug, the a short course of c/s.

Many of the clients I see want a cheap instant fix, and will almost never pay for any investigation. These guys get anti-parasitics, such as Bravecto, short course of preds, and kicked to touch. The one's that come back moan, but almost never consent to investigation. I try to get good skin scrapes if nothing else.

RE: Apoquel

Anthony Todd — Wed, 03 Jun 2020 10:13:15 GMT

[quote userid="13891" url="~/001/veterinary-clinical/small-animal/dermatology/f/discussions/29137/apoquel/223222"]severely pruritic patients (e.g. scabies)[/quote]

Anyone using Eurax for localised scabies, antipruritic, scabicidal, works very well, brilliant on ear pinnae, and on humans as a diagnostic aid on inner arms, chest and neck.

[Great for pregnant mums with itchy tums!]

[non prescription too]

RE: Apoquel

KMurphy — Wed, 03 Jun 2020 08:56:59 GMT

[quote userid="13891" url="~/001/veterinary-clinical/small-animal/dermatology/f/discussions/29137/apoquel/223222"]The manufacturer may have some data that they will share with you about the use of Apoquel in young dogs and give you a 'feeling' but no more of whether it is a good thing to use and those braver than me might try it anyway. [/quote]

I actually contacted them about this recently. If you read the EMA document (I wish I hadn't, it's horrific as they often are!), the recommendation comes from overdose studies where young dogs developed severe demodicosis secondary to immunosuppression and so use of apoquel was not recommended at all in this bracket. Cytopoint would be the preferred treatment for a 6 month old pup. Zoetis just said no to using apoquel in dogs under 12m old.

RE: Apoquel

Judith Joyce — Wed, 03 Jun 2020 06:59:23 GMT

I haven't used Apoquel in a six month old dog. The second contraindication on the data sheet "Do not use in dogs less than 12 months of age or less than 3 kg bodyweight." would make me reluctant to do so. There is no caveat such as 'use with care', 'not recommended' as with contraindications further down the list.

I would always take extra care to make a definitive diagnosis before using any antipruritic/antinflammatory agent in a young dog. Despite the effficacy of ectoparasiticides, lots of factors, including client compliance, prevent them from being 100% effective, so a thorough 'bug hunt' is still mandatory (before using the ectoparasiticides).

I sometimes find I have to use very short courses of glucocorticoids in severely pruritic patients (e.g. scabies) but topical and supportive treatments have often obviated the need for them.

The manufacturer may have some data that they will share with you about the use of Apoquel in young dogs and give you a 'feeling' but no more of whether it is a good thing to use and those braver than me might try it anyway.

RE: Apoquel

Vet2Vet — Tue, 02 Jun 2020 22:28:29 GMT

No not really . Aware it’s contraindicated in this age group but I have heard anecdotally that it has been used by some vets . I was wondering if there were any plus points as to why people might still consider it or with readily available cytopoint and even prednisolone if anyone has experience of its use in this age group.Considering no replies assuming other alternatives would supersede . I have used apoquel frequently in older dogs to good effect with obviously good case and patient selection . Just curious on hearing of its use if there’s anything I’m missing . Personally also reluctant to use steroids in animals around or below six months - would need a very good reason .Any thoughts welcome - positive or negative

RE: Apoquel

Freya . — Tue, 02 Jun 2020 22:11:18 GMT

This seems a bit of a strange question or atleast a strangely worded question. Do you have a 6 month old dog you were thinking of using it for? Apoquel generally is a pretty helpful drug for pruritic dogs.

RE: Apoquel

Vet2Vet — Tue, 02 Jun 2020 20:58:27 GMT

Anyone even heard of this ?