September 2024

By Dr. Natalie Young, PharmD, BCSCP, FACVP

Oclacitinib’s Dual Benefit: Easing Allergies and Limiting Antibiotic Use in Dogs

In this VETgirl online veterinary continuing education blog, Dr. Natalie Young, PharmD, BCSCP, FACVP discusses Oclacitinib, introduced to the veterinary market by Zoetis in 2013, which brought about a major transformation in the field of veterinary dermatology. This Janus Kinase 1 (JAK1) inhibitor changed the landscape of treatment for canine allergic dermatitis and atopic dermatitis, providing rapid relief from itching and inflammation, two of the most distressing symptoms for dogs and their owners. Its ability to selectively inhibit cytokines involved in pruritus and inflammation marked a shift away from more broadly immunosuppressive therapies such as corticosteroids and cyclosporine.

As it has gained widespread use, veterinarians and researchers have begun to recognize another important benefit: its potential to reduce the need for antimicrobial therapy. Allergic dermatitis is often complicated by secondary bacterial and fungal infections, which commonly require antimicrobial treatment. However, with organizations like the World Health Organization (WHO), Food and Drug Administration (FDA), and American Veterinary Medical Association (AVMA) emphasizing antimicrobial stewardship due to the growing threat of antimicrobial resistance, there is increasing pressure on veterinary professionals to reduce unnecessary antibiotic use. Oclacitinib’s ability to reduce inflammation and pruritus may, in turn, limit the occurrence of secondary infections, and thus, reduce the need for antimicrobials. Over the last few years, several studies have been conducted to explore the link between oclacitinib use and a decrease in concomitant antimicrobial therapy.

brown dog is scratching on white table

The first key study on this topic was published in 2021 by Rynhoud et al. This study involved a retrospective review of 58 dogs treated with oclacitinib and 205 control dogs receiving other anti-pruritic therapies at a small animal university hospital in Australia. The study aimed to evaluate whether oclacitinib could reduce the need for both systemic and topical antimicrobial therapies. Results demonstrated that dogs treated with oclacitinib had lower odds of being prescribed systemic antibiotics versus controls, which included treatments such as corticosteroids, cyclosporine, and antihistamines (OR: 0.29; 95% CI: 0.12-0.71, p = 0.007). In particular, there was a reduction in the use of systemic amoxicillin-clavulanic acid (OR: 0.08; 95% CI: 0.01-0.71, p = 0.024), as well as topical neomycin (OR: 0.3; 95% CI: 0.1-0.89, p = 0.029). This significant reduction in antimicrobial use highlighted that controlling inflammation and pruritus with oclacitinib can help reduce the frequency of secondary infections often requiring antibiotics​.

Following the initial findings, Rynhoud et al. conducted a larger, Australia-wide case-control study, analyzing 1,345 dogs treated with oclacitinib and 5,380 control dogs receiving other therapies. The study found that dogs treated with oclacitinib had a significantly lower chance of being prescribed cefovecin (OR: 0.62; 95% CI: 0.39-0.98, p = 0.043), chlorhexidine (OR: 0.57; 95% CI: 0.42-0.77, p < 0.001), neomycin (OR: 0.4; 95% CI: 0.28-0.56, p < 0.001), and amoxicillin-clavulanic acid (OR: 0.55; 95% CI: 0.39-0.78, p = 0.001) in cases compared to controls. This large-scale study reinforced that oclacitinib’s anti-inflammatory effects contributed to the reduction of antimicrobial prescriptions even in routine general practice, further supporting its role in promoting antimicrobial stewardship.

A more recent study, published in 2023 by Mwacalimba et al., built on these findings by expanding the scope of the research to 1,134 hospitals across the United States. This study involved 5,132 dogs treated with oclacitinib and assessed both the reduction in antimicrobial therapy and the overall quality of life for the dogs. Over eight weeks, an 83% reduction in the need for concomitant therapies, including a 100% reduction in systemic antimicrobial use was reported. Additionally, the study demonstrated a significant 70% reduction in dermatitis severity and improvement in both owner and dog quality of life.

Together, these studies illustrate the multifaceted benefits of oclacitinib in the treatment of canine allergic dermatitis. Not only does it rapidly and effectively control pruritus and inflammation, but it also contributes to a reduction in the need for antimicrobial therapies by helping prevent the secondary infections that often accompany chronic skin inflammation. In an era where antimicrobial resistance is an ever-growing concern, these findings underscore the importance of incorporating oclacitinib into treatment protocols for allergic dermatitis as a means to promote responsible antimicrobial use. As veterinarians continue to seek ways to improve patient outcomes while reducing the reliance on antibiotics, oclacitinib offers a valuable tool that aligns with global efforts to protect both animal and public health.

References

  1. Apoquel® (oclacitinib) package insert. Zoetis Inc. https://www.zoetisus.com/content/_assets/docs/vmips/package-inserts/apoquel-chewable-prescribing-information.pdf. Accessed September 1, 2024.
  2. Rynhoud H, Gibson JS, Meler E, et al. The association between the use of oclacitinib and antibacterial therapy in dogs with allergic dermatitis: a retrospective case-control study. Front Vet Sci.2021;8:631443. doi:10.3389/fvets.2021.631443.
  3. Rynhoud H, Croton C, Henry G, et al. The effects of oclacitinib treatment on antimicrobial usage in allergic dogs in primary practice: an Australia-wide case-control study. BMC Vet Res.2022;18(1):151. doi:10.1186/s12917-022-03255-y.
  4. Mwacalimba K, Hillier A, Rosenbaum M, et al. Diminished antimicrobial drug use in dogs with allergic dermatitis treated with oclacitinib. Front Vet Sci.2023;10:1207582. doi:10.3389/fvets.2023.1207582.

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