Cytopoint VS Apoquel for Itchy Pups

What is Cytopoint and how does it work? 

 Cytopoint is a monoclonal antibody, Lokivetmab that binds to IL-31, a pruritogenic cytokine, or simply put the “itch-sensation cytokine”. By binding IL-31 in the body thereby preventing it from binding to its receptor on nerves of the skin, Cytopoint rapidly reduces the transmission of itch (pruritus) linked to canine allergic dermatitis.

What is Apoquel and how does it work?   
Apoquel is a newer drug on the market, it contains the active ingredient Oclacitinib. It is a selective Janus kinase (JAK) inhibitor, mainly acting against JAK1 and JAK3. JAK is a family of proteins that play a crucial role in the body’s signalling transduction pathways.

It has both antipruritic (anti-itch) and anti-inflammatory properties. As such, it decreases the production of IL-2, IL-4, IL-6, IL-13 and IL-31 (the itch-producing cytokine mentioned earlier).

“Apoquel is a newer drug on the market, it contains the active ingredient Oclacitinib. It is a selective Janus kinase (JAK) inhibitor, mainly acting against JAK1 and JAK3."

What are the main differences bet Cytopoint and Apoquel?   
The main difference is the method of administration. Cytopoint is an, on average, once a month injection into the skin. Apoquel, on the other hand, requires daily oral dosing.

Additionally, Cytopoint was specifically created to target itch associated with atopic (environmental) allergies. However, it can be used for food allergies as well. It has been demonstrated to also assist dogs in other skin allergies where the specific cause of allergic dermatitis may be uncertain.

Apoquel, however, is labelled for pruritis (itch) associated with any allergic disorder, including flea allergy dermatitis, food allergies, as well as canine atopic dermatitis.

We describe atopic dermatitis in dogs as hypersensitivity or over-reaction to a range of common and otherwise harmless substances in the environment.

In what cases would you prescribe either or both? What factors do you consider?   
Apoquel tends to be my preferred treatment for most dogs during an allergy workup period. It has a short half-life and as such, is out of an animal’s system within a few days. This way, we can assess quickly if our treatment trials have been helpful.

This is harder to achieve with cytopoint as it has effects that can last anywhere from 4 to 8 weeks and itch control cannot simply be started and stopped as you could with Apoquel. Apoquel is also a great use for dogs adverse to vet visits.

There are, however, scenarios where Cytopoint is a better first-line option. For example, when:

• we can’t accurately dose Apoquel for dogs that are too small
• the dog is younger than one year old
• there’s difficulty pilling or owners have physical limitations that make administration of medications a struggle

I also commonly use Cytopoint to manage cases of adult-onset of demodicosis (infestation by the mite Demodex). In such cases, the pet’s immune system is unable to keep the mites under control so Cytopoint is able to provide good itch relief while allowing the immune system to work at full capacity.

I do use both concurrently during a flareup event where the dog has been triggered by an allergen and requires additional anti-itch relief. For example, if a dog on Cytopoint is doing well but lapsed on anti-flea control and subsequently presents pruritic (itch) for Flea Allergy Dermatitis, I use a short course of Apoquel to assist the animal in feeling more comfortable

Other factors that I do consider are mainly the patient’s concurrent medications and medical conditions.

In your experience, which is more promising/effective?   
Both drugs are much better alternatives compared to the use of older immunosuppressants, such as steroids and cyclosporin (Atopica). I would not consider one more promising or effective over another.

However, both Cytopoint and Apoquel may not be as effective in dealing with pruritus (itch) associated with severe pododermatitis (inflammation of the skin of the paw) or in ear infections. Steroids may sometimes still be required. Further studies pertaining to these are still ongoing.

Presently, I tend to prefer Apoquel because of:

• the flexibility with dosing and
• it being a more affordable option for many owners

Your veterinarian would be able to advise you on which may be a more suitable option for your dog.