Several readers asked us about Cytopoint, a newer medication to relieve itchy skin in dogs, and how it is different than Apoquel after an article we recently penned about the latter.
What is the difference between Cytopoint and Apoquel?
Apoquel (oclacitinib) is a synthetic medication that modulates two (JAK1 and JAK3) out the four known Janus Kinase (JAK) enzymes. JAKs are important in white and red blood cell formation, immunity, inflammation, and also act as sentinels in the body to potentially help protect against tumor formation.
Once the JAKs are inhibited, inflammatory cytokines – that result in inflammation and itching – are slowed or stopped. The cytokines affected are interleukin-2 (IL-2), IL-4, IL-6, and IL-13 for allergy and inflammation. Another cytokine, IL-31, is also affected, but it is the one associated with itchy skin (pruritis).
However, Apoquel affects several important body functions as well as to simply stop itchy skin.
Used for the long-term, Apoquel can lead to a decrease in white blood cells and elevated liver values. Additionally, it increases a dog’s susceptibility to infection and neoplasms, which are new and abnormal growths of tissue in some part of a body that are characteristic of cancers such as mast cell tumors or even adenocarcinoma.
Cytopoint, by contrast, is a very appropriate name for this newer medication. Cytopoint is a protein (monoclonal antibody) and directly binds to the cytokine, IL-31, which is the one associated with chronic itching.
Long-term studies have not yet been published regarding Cytopoint, but very few side effects have been reported in clinical cases. Generally, fatigue has been noted within the first 24-48 hours after injection.
A researcher noted that a few cases showed diminished response with each additional injection, suggesting that antibodies to Cytopoint were developing (a process called tachypylaxis = rapid and short-term onset of drug tolerance).
So instead of affecting many different parts of the body like Apoquel, Cytopoint gets to the point: targeting the exact cytokine that causes the itchy skin.
Are Cytopoint and Apoquel given differently?
Apoquel is an oral and daily medication. However, the manufacturer states that a dog caregiver can give Apoquel for short periods of time and that itch relief should occur within 4 hours.
Cytopoint is an injection given every four to eight weeks by a veterinarian. The manufacturer (same one for both drugs) says that some dogs may need year-round continuous treatment, whereas other dogs may only need it when itchiness flares.
Any other options?
Another option is allergen-specific immunotherapy, although this author has had limited success with it. It functions by gradually increasing the given dosage amount of the specific antigen(s) causing the problem until the tolerance threshold has been achieved. Immunotherapy for environmental antigens can be administered via injectable shots (Allergen-Specific Immunotherapy; ASIT) or a newer treatment option that puts a few drops under the tongue (Sublingual Immunotherapy; SLIT). ASIT and SLIT are specifically tailored to the individual pet.
If the treatment is successful, veterinarians might be able to extend the interval between administrations or cease treatments altogether, but this therapy has an uneven success rate. The success rate for ASIT to alleviate symptoms is stated to be approximately 60-80% and SLIT has been around 60%.
Side effects are noted to be uncommon but they can include injection-site reactions and the rare potential for anaphylactic shock. Thus, we should use caution when prescribing this protocol for environmental allergies.
Dr. Dodds and Hemopet Holistic Care clinic use Cytopoint for chronic atopic dermatitis in severe cases, but only after certain steps are taken first.
#1. Figure out what is causing your companion dog’s itchy skin
Jumping into immediate itch relief – without knowing the exact cause or causes of the itch – may quell a problem, but doesn’t address the underlying cause which needs to be eliminated. On top of that, it can be costly.
So, first, proper testing needs to be completed.
Itchy skin is often caused by a food sensitivity or intolerance. So, it is preferred to eliminate any documented reactive food proteins from your companion dog’s diet. For this, we suggest NutriScan Food Sensitivity and Intolerance Test for Dogs. NutriScan testing is recommended every 18 months, starting around puberty. Food reactivities can change and are cumulative as pets age.
At the same time, you should also have a serum-based blood test completed for seasonal and environmental allergens such as grasses, weeds, trees, wool, cotton, pollen, mold, fungi, dust mites, fleas, etc. Hemopet also offers this testing.
After NutriScan testing, many dog parents realize that they must carefully read all ingredient labels to be sure that the product is appropriate to feed. They remark that they are happy to have their dogs no longer itching, but also admit that sometimes finding the right foods can frustrating. Hemopet offers an inexpensive consultation to review the results and suggest suitable food options.
Regardless, it is easier to eliminate one or more reactive foods than environmental allergens. Exposure to environmental allergens can be minimized. For instance, if your dog has a reaction to grass, you can wipe off his paws after a walk or have him wear booties. However, if these preventative measures do not work to minimize the reaction, talk to your veterinarian about Cytopoint.
Canine Atopic Dermatitis Immunotherapeutic Injection, CADI Injection. Zoetis US, https://www.zoetisus.com/products/dogs/cytopoint/index.aspx.
Cosgrove, Sallie B., et al. “Long-Term Compassionate Use of Oclacitinib in Dogs with Atopic and Allergic Skin Disease: Safety, Efficacy and Quality of Life.” Veterinary Dermatology, vol. 26, no. 3, 2015, doi:10.1111/vde.12194, https://onlinelibrary.wiley.com/doi/full/10.1111/vde.12194.
Gonzales, A J et al. “Oclacitinib (APOQUEL(®)) is a novel Janus kinase inhibitor with activity against cytokines involved in allergy” Journal of veterinary pharmacology and therapeutics vol. 37, no. 4, 2014, 317-24, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4265276/.
Pieper, Jason. “Atopic Dermatitis: Steroids vs. Atopica vs. Apoquel vs. Cytopoint.” University of Illinois College of Veterinary Medicine, 18 Jan. 2017, http://www.vetmed.illinois.edu/steroids-vs-atopica-vs-apoquel-vs-cytopoint/.