APOQUEL: will it live up to expectations?

Jon D. Plant, DVM, Dipl. ACVD

If you haven’t already, you will soon be hearing a lot about APOQUEL® for the management of allergic dermatitis and atopic dermatitis in dogs at least 12 months of age. APOQUEL® is a new drug from Zoetis that controls pruritus and inflammation by inhibiting janus kinase enzymes, and is therefore known as a JAK inhibitor.

APOQUEL significantly reduces itch within 24 hours, with continued improvement during the first 7-14 days of therapy. In clinical trials, APOQUEL-treated dogs with atopic dermatitis were evaluated after 28 days by the owners and veterinarians.  66% of dogs treated with APOQUEL and 4% of dogs treated with placebo were judged to have a significant reduction of itching.  Significant improvement was defined (in collaboration with the FDA) as a 2 cm reduction on a 10 cm pruritus visual analog scale (PVAS). Is this a case of what epidemiologist John Ioannidis calls “significance chasing?” Are the findings statistically significant, but clinically trivial?

The percent of dogs that achieved a “normal dog” level of itch (< 2.0 on the PVAS) has not been made available to us. This is, of course, the outcome measure than would mean the most to the owner of a pruritic dog, and the one that I am most interested in determining, even if the FDA was not.

I have had the opportunity prescribe APOQUEL to 20 dogs in the past 3 weeks, with follow-up examinations planned after 4 weeks of treatment. I’ve asked each owner to grade pruritus daily with the PVAS and am curious to see how many get into the “normal dog” range on the pruritus scale.  Will APOQUEL live up to the hype?  I hope so! But, I think we will all be more confident after we have some first-hand experience. APOQUEL is scheduled to be launched in January.

In my next post I’ll discuss the safety of APOQUEL and the patient monitoring that I am recommending to my clients.

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About skinvet

Jon Plant, DVM, is a Diplomate of the American College of Veterinary Dermatology, founder of SkinVet Clinic and developer of RESPIT, regionally-specific immunotheray for atopic dermatitis of dogs and cats. He is a member of the International Committee on Atopic Diseases of Animals, the past President of the Portland Veterinary Medical Association and the Dermatology Section Editor of the Journal of the American Animal Hospital Association.
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10 Responses to APOQUEL: will it live up to expectations?

  1. Tom Rock says:

    It is a miracle drug. My dog has been on it for three days and she has stopped scratching, and no longer licks her feet and behind.

  2. Brian says:

    Looking forward to your analysis on safety of this drug. Subscribed.

  3. John Campbell says:

    Our dog, Leo, has stopped itching and biting himself. It is truly a miracle drug. We were going crazy with his condition before the vet suggested apoquel. Leo is back to being himself, playing with his toys and never itching himself. Hope this treatment helps other dogs with similar conditions. Keep up the good work in finding a cure for animals… Thanks!

  4. Dana says:

    Our dog, Zeus is going through allergy therapy. He was miserable and so were we. He was bloody from scratching. We started him on this drug 7 days ago and he has not scratched since, even with a large dose of the allergy therapy. He is healing and he is happy. We have our wonderful lab back. Can’t say enough…it is truly a miracle seeing this transformation in such a short period of time.

  5. skinvet says:

    Yes! I have had patients whose itching has disappeared after the first dose! Although it works great, we still need to use Apoquel in the right patients, control secondary infections, and monitor them carefully.

    • Liz Taft says:

      My Westie has been biting her paws for over a year. Her blood test revealed ahe was allergic to a very long list of foods and airborne and contact allergens. With our Vet we tried everything – homemade food, steroids, Chinese herbs, special shampoo, washing her paws after being outside and then we found Apoquel! It started working within 4 hours! Lily has been taking Apoquel for almost 3 months. All of her paws have thick fur, her coat and tail are full and healthy. She doesn’t bite herself anymore! She has her puppy spirit back because she is not biting hersel all day and through the night! She is more calm now too! It is a miracle drug and when my vet ran out of it, I bought it online. So happy a cure was found for this and all of the other itchy dogs!

      • skinvet says:

        Liz,
        So glad your girl is feeling better! Most of my patients are doing quite well on Apoquel. I would be remiss if I didn’t point out that blood tests are notoriously inaccurate for food allergy diagnosis (and even for airborne allergens).
        Jon Plant, DVM, DACVD

  6. Pingback: Apoquel: a new drug for dogs with allergic dermatitis | Itchy Dog Blog

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