By Jon Plant, DVM, DACVD
Bad news, good news about Apoquel® from Zoetis (NYSE: ZTS). We learned last week that the Apoquel backorder situation is likely to continue throughout 2014 and into the summer of 2015. That is very sad news for many itchy dogs and their owners. On the positive side, those of us who started a lot of dogs on Apoquel when it was first released will seemingly have our current patients’ Apoquel requirements met, with regular allotments available for auto-shipping.
Despite the shortcomings in the supply, I am still a big fan of Apoquel based on my experience treating about 100 dogs. I have seen the pruritus (itch) score drop from a mean of 6.0/10 when beginning therapy to 2.5 after 4 weeks (the first point at which the score was recorded). In most cases, owners report that the pruritus improves within a few days, in accordance with the reports and publications from Zoetis. Meanwhile, I see very few adverse reactions. It is truly amazing and my clients are, on the whole, very grateful.
The Apoquel shortage leaves veterinarians with the traditional methods of controlling atopic dermatitis (“allergies”). The first step is to make the correct diagnosis by using a validated checklist and ruling out alternative diagnoses (see my short video on diagnosing atopic dermatitis). Once the diagnosis is made, the proven alternatives to Apoquel for effective therapy are:
- Glucocorticoids – usually effective, but frequently cause undesirable short and long-term side effects.
- Atopica® — often effective, but may cause vomiting and other gastrointestinal side effects.
- Allergen testing/immunotherapy – both serum IgE testing and intradermal testing have reliability issues. See my recently published study that demonstrates that there is poor agreement between four serum IgE assays when you take into consideration random agreement.1 What is the value to the pet owner if we can’t be confident that the results are much more accurate than guessing?
All of which led me to develop RESPIT®, regionally-specific immunotherapy, a patent-pending approach that allows veterinarians to effectively desensitize patients with allergen mixtures optimized for their geographic region rather than based on an allergen test of questionable accuracy. Consider the following:
- Every allergen testing company and most veterinary dermatologists report similar levels of efficacy for their immunotherapy based on these discrepant test results.
- A committee composed of experts on canine atopic dermatitis found that there was no evidence to recommend one form of testing over another.2
- Another study found that immunotherapy with a standardized allergen mixture is as effective as immunotherapy based on intradermal test results.3
Why are we still using these tests??? Would we submit blood for CBC’s if every lab gave us different results and we didn’t know which, if any, was accurate? More and more veterinarians are recommending RESPIT, recognizing it as a practical and cost-effective approach when you consider the facts about allergy testing.
1. Plant JD, Neradelik MB, Polissar NL, et al. Agreement between allergen-specific IgE assays and ensuing immunotherapy recommendations from four commercial laboratories in the USA. Vet Dermatol 2014;25:15-e16. Best Clinical Research by an Established Investigator Award, ECVD-ESVD Congress, 2013.
2. Olivry T, DeBoer DJ, Favrot C, et al. Treatment of canine atopic dermatitis: 2010 clinical practice guidelines from the International Task Force on Canine Atopic Dermatitis. Vet Dermatol 2010;21:233-248.
3. Garfield R. Injection immunotherapy in the treatment of canine atopic dermatitis: comparison of 3 hyposensitization protocols. 8th Annual Members’ Meeting of the American Academy of Veterinary Dermatology & the American College of Veterinary Dermatology 1992:7-8.