We started hearing about a new drug to control the itch of allergic dermatitis and canine atopic dermatitis in dogs over 1 year of age at the Vancouver World Congress of Veterinary Dermatology. Like most veterinary dermatologists, I was eager to try it in my practice. I started prescribing (oclacitinib) Apoquel® for itchy dogs at SkinVet Clinic in November 2013. Although there are now several peer-reviewed publications on the safety and efficacy of Apoquel , I would like to share my experience with the first 117 dogs that I treated.
The clinical sign of most importance to pet owners of dogs with atopic or allergic dermatitis is pruritus (itch). At SkinVet Clinic, we ask pet owners to grade their dog’s itch level at each examination using a validated visual analog scale (0 – 10). While this is the best method that we have had to grade itch in practice, it gives an incomplete picture of itch severity over time. Soon, pet owners and veterinarians will be able to easily record and view a more complete itch diary using the Itchology app for iPhones (see www.itchology.com for more info and to sign up to get notified when it is released).
Figure 1 shows the owner-reported itch level of dogs pre-treatment and at months 1, 3 and 6. Both per-protocol data (dogs returned for recommended follow-up examinations at 1, 3, and 6 months) and intent-to-treat (ITT) data (previous value carried forward when dogs did not return for examinations or medication was discontinued) are shown.
- 117 dogs started taking Apoquel at least 40 days ago (day 0 median = 6.0). Month 1 itch level scores were available for 104 of these (median = 2.5). The ITT data yielded similar results taking into account carried-forward values for the 13 dogs that did not return (median = 2.7).
- 108 dogs started taking Apooquel at least 3 months ago (day 0 median = 6.0). Month 3 itch level scores were available for 85 of these (median = 2.0). The ITT value was slightly higher (median = 2.5).
- 91 dogs started taking Apoquel at least 6 months ago (day 0 median of these 91 dogs = 5.7). Month 6 itch level scores were available for 59 of these (median = 2.3). The ITT value was similar (median = 2.5).
- The percentage of dogs that achieved a level of itch considered “normal” by dog owners (0.0-1.9) was 36.8% at 1 month, 39.8% at 3 months, and 40.7% at 6 months (based on ITT values). Many others were in the “very mild” itch category.
These findings are remarkable, considering that most of the dogs began taking Apoquel during cooler, winter months and follow-up examinations more often occurred during warmer months, when many dogs with allergies would be flaring up. Further, as this was not a rigorous clinical trial, the day 0 itch level was often recorded while the dogs were still taking other medications – from prednisone to Atopica®. (These were discontinued for three days prior to the owner initiating Apoquel, in most cases.) Therefore, it is likely that the day 0 itch level reported here was slightly lower than it would have been with a medication wash-out period.
All in all, Apoquel has performed very well in my hands.