Apoquel has been more consistently available during the past year affording the opportunity to appreciate where best to consider its use.
Apoquel has been effective in managing pruritus in the majority of patients treated with approximately 80% demonstrating excellent response within 48 to 72 hours of treatment with b.i.d. dosing.
Some patients will develop a significant degree of pruritus near the end of the 24-hour dosing period when the dose is reduced to once daily. Dividing the once daily dose to bid can provide more consistent relief to approximately 5% of these patients. It’s important to note that some patients benefiting with Apoquel therapy may still experience enough allergic disease to still develop a secondary bacterial and/or Malassezia dermatitis which may be perceived by the owner as therapy not adequately controlling pruritus. If patients may be appearing less responsive with continued therapy it is important to re-evaluate your patients to determine the cause of their persisting pruritus and not just increase to bid dosing or assume they are developing a tolerance to Apoquel.
Apoquel should not be combined with other immunosuppressive agents, including corticosteroids and oral cyclosporine. Alternative treatments to consider may include the new canine atopic dermatitis immunotherapeutic monoclonal antibody injection. Intuitively we would assume that if Apoquel were ineffective, then the immunotherapeutic injection would also be ineffective but this is not always what occurs clinically. It is also important to rule out demodicosis in patients that are treated and then are no longer responsive because Apoquel may predispose to the development of demodicosis. We are pleased to offer Apoquel to our pruritic patients but have realized owners have misperceived the drug as having no side effects.
Unfortunately, the common diagnostics of a complete blood cell count, serum biochemical profile and urinalysis often do not identify the degree of immunosuppression that is occurring. The FDA approval studies identified a reduction in lymphoid tissue within lymph nodes, bone marrow and splenic tissue especially with higher dosing. Our usual screening diagnostics do not recognize these changes. Therefore, it is important to continue to evaluate for a non-immunosuppressive therapeutic option for your patients if considering chronic therapy with Apoquel. If you have questions regarding any of the topics discussed please do not hesitate to contact any of our board-certified dermatologists.