The hot topic in the world of dermatology right now is Apoquel. Apoquel is an exciting new medication for the treatment of allergic itching in dogs. It has a different mechanism of action than steroids, cyclosporine, antihistamines, allergy shots and sublingual immunotherapy. Apoquel suppresses part of the immune system through the Jak/Stat pathway.
Apoquel was made available a few months ago, and then promptly went on back order. During the short time that it was available, the dermatologists at McKeever Dermatology were able to prescribe it to 250 dogs. The following is our experience…
- Apoquel is given by mouth twice daily for 2 weeks, then once daily thereafter. Apoquel is metabolized and eliminated quickly from the body. Some dogs experience a pruritus breakthrough within 12 to 18 hours of receiving an Apoquel dose.
- More than 80% of dogs will experience itch relief when Apoquel is administered twice per day. Approximately 60% of dogs will experience itch relief with once daily dosing. Apoquel works as quickly as steroids in many dogs. If the itching is not controlled within one week, then it is unlikely to be effective.
- The conundrum occurs with the allergic patient whose itching is controlled with twice daily dosing, but not once daily dosing. We still do not know how imperative it is for dogs to strictly adhere to the q 24 hours dose for chronic use.
- Some allergic dogs will use Apoquel as part of combination therapy. Apoquel can be combined with antibiotics, anti-fungals, antihistamines, topical steroids, allergy shots and sublingual immunotherapy. Apoquel does not interfere with allergy testing.
- We have combined Apoquel and short-term oral steroids with no apparent problems. No data is available for concurrent cyclosporine and Apoquel use. At this time we are avoiding that combination.
- Side effects include possible bone marrow suppression in dogs receiving higher doses.
- About 10% of dogs will experience diarrhea. Apoquel is not for use in dogs less than one year of age or dogs with systemic infection.
- We monitor Apoquel with a CBC/mini chemistry after 1 month, then CBC/chemistry/UA after 6 months of use. We may monitor CBCs more frequently in a patient using Apoquel off label.