Cytopoint: The New Dog Allergy Medicine

Updated April 3rd, 2020

Just read this message. Can it be that we are finally able to help these poor dogs?

“I have a Westie with atopic dermatitis. Have just started on Cytopoint – 2nd injection last week. First one lasted 6 weeks. Have been vilified on a number of FB groups as have other Westie members. Last week was told “well if you want your dog to go blind it is up to you.”

After 5 years my boy has found relief. Tried Atopica and Apoquel. Lots of steroids and antibiotics. Diet. Raw. Grain free. Hypoallergenic. Elimination. Malaseb. Baking soda. Iodine. Tee Tree oil. Oatmeal shampoo and conditioner. Sox. Bootees. Sandals. Onesies. Everything except the cone of shame.”

Cytopoint is definitely a big leap forward and stories like this are really happening. But just as with any new product, it’s a vet’s responsibility to be critical too.

What Is Cytopoint?

Cytopoint® or lokivetmab is the newest treatment for skin allergy in dogs. It’s a monoclonal antibody made to bind and inactivate an inflammatory messenger called IL-31. This is the cytokine found at high levels in dogs with atopic dermatitis, but not in normal dogs. It’s the first medicine of its type in the veterinary world.

Cytopoint comes as an injection to be given under the skin every 4 weeks. Like any protein or peptide, it can’t be given orally without the gut destroying it. However, once injected it has a long life in the circulation.

Cytopoint is the latest in what is becoming a pleasantly crowded market for dogs with atopic dermatitis. I’ve discussed most treatments for itchy dogs elsewhere, but let’s compare a few similar ones here.

Cytopoint vs Apoquel

Apoquel® is also a drug that blocks IL-31, this time by inhibiting its production, and could almost be considered a tablet version of Cytopoint. However, in addition it blocks four other inflammatory cytokines. This means that while Apoquel may work better for certain types of inflammation, it’s also less specific.

Generally, less specific drugs have higher rates of side effects, and that’s been our experience too. Apoquel is a lot safer than what came before, but I don’t think any vet will deny that Cytopoint is better still.

Apoquel is also much shorter-acting. The tablets is only be given once a day but my dog Loki was typical in that the effect wore off a little too early. Once Cytopoint arrived I switched him over both for efficacy and safety reasons.

Reasons you might prefer Apoquel are:

  • Cost: Cytopoint is generally more expensive depending on body size
  • Convenience: you don’t need to go to the vet as often
  • Needle phobias: Apoquel is easy to hide in a treat each day

If Apoquel is already working well for your dog, there’s no reason to change. It’s usually effective and well-tolerated. You can read about the side effects, cost and dose of Apoquel here.

Cytopoint vs Atopica

Atopica® is a drug that was once the best we had but that’s a long time ago now. Nowadays I would only try it on an atopic dog if everything else had failed. Read more about Atopica here.

As an immunosuppressive, side effects are also more of an issue. It commonly causes vomiting, plus gum and coat changes. Atopica will remain a very valuable drug for many auto-immune diseases. And of course if it’s working well for your atopic dog, there’s no reason to change.

Cytopoint vs Prednisolone

It’s quite ironic that the poor lady at the start was accused of harming her dog with Cytopoint but not prednisolone. Good old ‘pred’ has always had an important role in veterinary medicine, but that’s not to say it’s safe.

Prednisolone, and prednisone in the USA, are synthetic analogues of the hormone cortisol, with an enhanced anti-inflammatory effect. Corticosteroids like these are very effective at controlling itch. Reasons prednisolone may be worth a try for your dog are:

  • Cost: It’s OK to use prednisolone if it’s the only one you can afford
  • Individual variation: around 30% of dogs respond without visible side-effects
  • A seasonal problem: side effects are less a concern with short-term use

Click here for a case study on the use of cortisone drugs in atopic dogs.

Side Effects & Safety Of Cytopoint

The advantage of using an antibody as a medicine is that they are already present in the body and extremely specific. This means we expect minimal side effects. So far, this seems to be true for Cytopoint.

Possible side effects include:

  • Lethargy
  • Hives, urticaria or other immune responses to a foreign protein
  • Reduction in efficacy due to development of antibodies to lokivetmab

Honestly, it would be surprising if there were any other safety issues. Be very wary of people reporting correlations or associations without proof (like blindness!). If you want to learn more, I’ve written about a similar safety debate with Bravecto.

A bigger disadvantage for most people is likely to be cost.

How Much Cytopoint Costs

The answer will depend on how your vet chooses to structure their fees. In our Adelaide clinic, Cytopoint injections cost between $111 and $130 for dogs from 3kg to 40kg bodyweight. However, the first two injections must be given by a vet, and therefore there will also be a consultation fee each time.

Once we are happy it’s the best treatment for your dog, further injections can be given by a nurse to reduce the cost.

How Long Cytopoint Lasts

After a Cytopoint injection, the itch should disappear within 24 hours, and then gradually return between 4 to 8 weeks. Therefore, Cytopoint is registered for 4-weekly injections to get the maximum effect.

There are some dogs who get a good response but do not achieve 4 weeks of relief. For these I recommend seeing if the effect will last longer with subsequent doses.

For good responders, I am quite happy if an owner waits until they see the injection wearing off before they come in again. The wearing off is gradual and reasonably harmless. It’s then possible to give future injections just before the itch would normally have returned.

I must stress that this is an off-label use of Cytopoint and therefore side effects and efficacy may vary from what is known.

The Best Drug For Itchy Dogs?

In finishing, let me say the same thing I said about Apoquel. Cytopoint is not a magic bullet and it shouldn’t be seen that way. It’s a highly specific treatment for only one skin disease of dogs, albeit the most common one.

Before using it, vets still need to make sure that the itch isn’t caused by something else. That could be fleas, food or infections to name just three. You are even welcome to ask for referral to a skin specialist to discuss options like desensitisation.

Then if you try Cytopoint, be prepared for it to fail, or to need other treatments at the same time. But don’t be put off by online scaremongering. It’s seriously the best relief my Loki has had, and he isn’t the only one.

By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. These blogs are from a series regularly posted on email and Twitter. Subscribe via email here to never miss a story!
Have something to add? Comments are welcome below and will appear within 24 hours.

Andrew

53 Replies to “Cytopoint: The New Dog Allergy Medicine”

  1. Hi. After reading your blog last year we started jasper on apoquel. He had been on 1/4 prednisone daily for years. He’d lick foot till all hair gone and of course cycle of licking and infecting it. I felt apoquel was a godsend. He’s been on it almost 12 mths. But this past week just after groomer ( and not sure if our long grass also did this ) noticed licking side of one foot and toes of another. He’s back in cone at the moment cause I can’t watch him 24/7.
    Im not sure if I should increase A
    He’s scratched a lot more under chin too.
    Could be a combination of groomer , heat , long grass. My mum passed away Thursday so jasper chewing his feet is another stress for me.

    1. Hi Liz. If the Apoquel has been working well, I would suspect there’s a short-term exacerbation like an infection or rash from the clippers, rather than the underlying problem coming back. Therefore, it may be a good idea to get your vet to take a closer look. However, it’s also true that some dogs on Apoquel do relapse in time (mine did so and I moved him to Cytopoint).

  2. We have a lovely Australian Blue Cattle dog/Frenchie mix. We adopted her from a shelter about 2 and 1/2 years ago and they told us that she’d been rescued from the streets and was so filthy and covered with fleas that they had to give her four flea baths. They said her constant itching, scratching, dry skin and fur was due to the flea baths and that it would all settle down in time. Well, that never happened and she continued to suffer for years. I tried so many different things from supplements to diet changes etc. Shampooing and conditioning helped for a day or 2 then it started up again. It drove us all crazy to see her suffering, we would even start to feel itchy just watching her. The vet told us she has allergies to dust mites and a list of other things. Recently she told us about Cytopoint and asked if we’d like to try it as it has few side effects. I agreed right away and we haven’t been sorry. Our little girl had her first injection about 2 and 1/2 weeks ago and it’s been a God send. The first day after getting the shot Eva stopped itching completely. So far it’s been fantastic! It cost $US99.00 plus the cost of the office visit, so it is rather expensive but she is worth it. Eva is just a part of this family as my children are and I would never worry about the cost at the expense of one of them suffering. We were told the vaccination could last from four weeks up until eight weeks. I’m hoping there are no adverse side effects because Cytopoint is helping Eva so much.

    1. Hi Tina. I suspect a lot of these dogs are surrendered because of the expense in treating their skin problems. I’m glad you found a possible solution, and I wouldn’t worry too much about side-effects as these seem rare using Cytopoint. (BTW apologies for not publishing your other comment on food – we try to avoid outside promotions, even when heartfelt).

      1. So to be clear, you’ll promote the paid for pharmaceutical product but not anything natural. Nice work. Vets are worse than GPs these days.

      2. Hi T. We always start with natural treatments but they have a ceiling to their effects that’s usually too low for adults with severe atopic dermatitis.

      3. Hi Andrew,
        I think you’ve touched on an important point regarding ‘discarding’ dogs when their skin problems become unaffordable. I can empathise because our monthly bill for Apoquel is ridiculous! Our 70kg Boerboel needs 4x 16mg tabs/day, with great difficulty we’ve reduced it to 3/day now. 2/day simply didn’t work. He’s been on it about a year now. So it was interesting to read the cost of Cytopoint for a 40kg dog is about $130 (aussie) per session which should at least last a month? What would the needed dose and cost be for a 70kg dog? Don’t even know if it’s available in S.Africa. Thanks.

  3. My westie was so miserable with itchy skin and he would get these horrible stinky sores, I was told to use a steroid which was OK but then caused him liver damage, I changed my vet and he suggested cytopoint, no more sores smell or itching and his coat looks amazing, it is expensive but he’s worth it, a much happier dog, I also wash him in Malaseb shampoo and hypoallergenic diet

  4. I have a 5 yr old westie, Freya. She has been allergy tested. Allergic to barley (which is in most dog food), storage mites (easy fix, freeze food), and dust (hardest thing of all). She is constantly chewing her feet. They are all brown, along with snout. Her feet swell, red, sometimes raw. She doesn’t scratch alot, its just her feet. Vet checked for yeast, no yeast. Shes on hydroxyzine twice a day, gets medicated baths (jax and daisy helped her have a beautiful coat), so its just her feet. We constantly mop, wash beds, dust (with her out of room) and wash her toys. Is cytopoint shots a good idea for her or does she need to be having problems all over. She did have problems with ears, eyes, etc but we found some mold and had it removed and instantly she felt and looked better, except her poor feet. Vet says its up to me if we want to try it. Just wondering your thoughts please!

    1. Hi Robin. Freya’s interdigital dermatitis is a manifestation of a systemic disease and therefore it is sensible to use a systemic treatment: either Cytopoint or Apoquel, but I would also warn that any improvement would be extremely slow given the pre-existing changes to the skin. It could take six months to see the benefit, with no guaranteed result. One personal observation I would make on cases like this is that I find testing for yeast in the feet quite unreliable. It’s reasonable to assume yeast infection in such a case, and it’s also quite easy to use daily antifungal foot wipes as a remedy. I would advise doing this as a long-term trial as well; ask your vet for local product recommendations.

  5. I gave my dog a shot of cyto point in November on the recommendation of my vet. By January we are now being told his liver enzymes are so high we may need to consider euthanasia.
    We have since found out that there have been limited trials of this drug and long term side effects are not known due to this.
    All stories which touch on side effect are within 2/3 months from the first shot.
    I believe that there is not enough testing and research on Cytopoint to consider it safe. Do your research before commuting to this. I wish I did as I cannot see any other reason for my dog to become so ill so soon after receiving this treatment.

    1. Hi Sarah. I’m sorry to hear about your dog. I would strongly encourage you to ask your vet about investigating the liver disease. Raised liver enzymes on their own come from a wide variety of causes and euthanasia is never appropriate solely from observing an elevation. Many of these are harmless, many can be treated, and liver enzyme elevations of all sorts are common. If the effects are from a toxic cause, these can typically be identified in a biopsy, which is safe and easily performed. It just might save a life. It’s especially important here as liver disease is not currently considered a risk in dogs receiving Cytopoint so it would be an important first step towards submitting an adverse reaction report to your local authorities in the UK which would put this in the public domain. If you get further information, please post it back here.

    2. Please try giving your liver dog milk thistle. Even my vet recomends it to patients with high readings. The liver can be helped if you don’t wait too long. I kept all my dog’s liver readings normal even at 15 and up with milk thistle and take it myself as well.

  6. Hi Andrew

    I have a chihuahua who has lower and upper airways problems. She has been prescribed Nuelin, Seretide 50/25 (spacer), Flixotide and I also give her Telfast. The problem is that she is very uncomfortable during the night with her tongue going in and out of her mouth. I tried stopping the Nuelin which seemed to help the problem, but this affected her breathing and comfortness.
    Can these little dogs have nasal surgery, and also are there any other medications that do not have the same side-effects as the Nuelin?

    Thank you
    David

  7. I have a 12 year old Field Spaniel. He was the picture of health up until the age of 4 and then chronic ear and skin problems. We have tried EVERYTHING!! Since January of this year his skin problems have been off the chart. We have had him on Apoquel, steroids, Atopica and finally tried the Cytopoint in July. The shot worked great in the beginning but the shot in October didn’t last as long. He just had another shot this week and it didn’t help at all. He has had flare ups but none that have lasted this long, almost a year now. I spot wash with shampoo on the trouble areas. Started giving him Omega-3 supplements and his skin turned around and cleared up completely. That lasted about a month before he went downhill again. Now I have run out of options and vets bills totaling of $3000 and this poor dog still suffers. If anyone has any other suggestions I’m all ears. We are now considering taking him to Tuft’s Veterinary Clinic but worried what that is going to cost. Feel so bad for these dogs and the people that take care of them. There doesn’t seem to be a solution that works for all.

    1. Hi Lou-Ann. I’m sorry to hear about your dog’s troubles. The best thing I can suggest is to take the referral opinion you are already considering – it nearly always justifies itself in improved control. My only other thought is that when these allergy medications fail, it’s most commonly due to secondary infections which require their own treatment. Good luck.

      1. Thank you and your right about secondary infections. When he goes for the Cytopoint shot he is also put on antibiotics because he usually has a secondary infection. Hoping this clinic will be able to find something to give this little guy a break from the itching. And thank you Andrew for your thoughts and your blog, very helpful.

    2. Sometimes it is worth it to take your dog to a University Hospital. With my Dog and a sudden back injury, I kept running to my Vet, running to the emergency Vet. Round and round. Hundreds of dollars and no relief for my dog. I went to the University of Minnesota. Within an hour and a half, I had a clear diagnosis, different meds to use, and knowledge about the injury. I think I spent $350 or so. Not a night and day improvement, but we were sure going in the right direction.

  8. My jasper has been a nightmare. Got him at 5 mths. He’s worn a cone on and off since then. He’s 8. Hes a toy poodle. Very flaky pink skin. He’s been on 1/4 prednisone daily for about 4 years. It’s the only thing that settled him. He’s had about a year without cone. Now wearing again since September. Licks toes on L foot. No hair. Upped the prednisone and antibiotics. Usually it settles but caught him sneaking a lick last night. I don’t think I’ll ever get on top of it. Once we went to All natural vet care here in Sydney. She gave Chinese herbs. Didn’t make a difference. Usually once it heals he forgets about it but not this month. We feed our food. No pet ranges. Chicken , rice , broccoli , pumpkin. It does my head in. I’ve lots of other things to do like work , elderly parents. My own kids. I have a black toy also and he’s fine.

  9. Cytopoint has been a lifesaver for our Frenchie. Though Apoquel worked, there was a marked increase in his chewing as soon as the pill wore off. The consistent relief is amazing. But he has suffered alopecia and a lot of thinning. So we will discontinue the injections and see if the hair regrows. Just something to be aware of!

  10. our bulldog was itching and licking non-stop for many months. decided to give Cytopoint a shot, and it worked instantly.

    hoping to get his skin issues healing and clearing up, and will attempt to keep him meds free indefinitely.

  11. Hi I have a westie and have been getting cutopoint injections…it appears to work although my fog will still lick herself. What I am concerned about is her hair falling out with crusty growths at the base of the hair. I am wondering is that a side effect of cutopoint or is it of tinasil tablets or something else. It is quite distressing trying to figure this out.

    1. Hi Di. This is common with Westies on Cytopoint- it’s likely to be a staphylococcal pyoderma. They are secondary to the underlying skin disease but don’t seem to be much less common when on Cytopoint even though the dog is less itchy. A disinfectant wash or antibiotic tablets are usually necessary.

      1. Thank you for responding. I am trying everything. My little westie likes to make things difficult by trying to avoid baths. Lol. It is an ongoing battle of the wits!

  12. We have a 7 yr old boxer who has been dealing with allergies for over 5 yrs – he was on pred a quarter tablet once a day for maybe 4 yrs with no issues however his latest bld work showed slightly elevated kidney protein and slightly lower thyroid – a wk ago he got his first shot but noticed today his skin is getting irritated again?!?! We cant afford this shot to be weekly but I dont think our vet will give us the pred again – what do we do?!?

    1. Hi Brena. It doesn’t sound like the prednisolone has been conclusively linked with the abnormalities in the blood parameters. In fact, I would be repeating these a month later and seeing if anything changes when the prednisone stops, but it’s also worth pointing out that a lower thyroid in a dog on prednisolone does not mean the dog is hypothyroid. There would be nothing wrong with you asking to restart the prednisolone and the vet recording a disclaimer on the file.

  13. Our dog has Lupus. His skin is dry and become black, hair is not being replaced.. very itchy, he doesn’t scratch but likes us to rub him and he rubs on us. No improvement after 1st dose cytopoint, should we continue. He has been on Imuran 6yrs, Minirin and gabapentin 6 months he is 12 yo Alaskan Malamute.

    1. Hi Cheryl. I won’t comment on the treatment of lupus, which is a rare and tricky disease. However I will say that in my experience if Cytopoint doesn’t work on the first dose it’s not going to.

  14. My girl Molly is a 7 year old 26 lb. Jack Russel who has been scratching for years especially her paws and sides. We have tried Everything!!!I took her to my vet to see what he could do for her. I new nothing about anything but Apoquel and all its side effects. I had given it to her for some time last an before but stopped and tried lotions and salves off the internet and nothing worked! My vet told me there were 3 different shots we could try. I can’t remember all but Cytopoint, Apoquel, and one with steroids. I went with Cytopoint and we can not believe what we see. That night she stopped scratching and I mean TOTALLY!
    She has shown no other changes. She is 200% Jack Russel and she does every thing just like before. WE are very attached to her and so thankful for our vet informing us of these possibilities. It did cost us 55.00 for the first and then 30.00 for the next shot.. We don’t care !!!! She was suffering just like one of us. I Pray it last as ( they say 1-3 months) we are on a fixed income and it does cost. Sorry about the long e-mail, I just want every one to know this is wonderful. Please help your babies.

    1. Hi Krys. The interdigital furunculosis is probably caused by the underlying skin disease, not the Apoquel. Given that we see Cytopoint performing better (as long as the problem is atopic dermatitis) it may be good to try.

    1. Hi Tony. The initial cost would be the injection ($120 in 2019) plus a consultation fee of $66.50. After that, the second injection has an injection fee of $38.90 added, and after that nurses give the injection without an extra fee in our clinic.

  15. My dog had an injection a day ago and his lethargy is getting alarming. Now he won’t eat, won’t take his favorite treat and I had to leash and make him go outside. he sticks to me like glue so I know he doesn’t feel like himself.

    1. Hi Bonnie. That’s very strange and definitely worth getting your vet to have another look at. If there’s any doubt, obviously don’t use Cytopoint again. All the best.

    1. Hi Yvette. It’s not registered for that use, but it’s possible it may work regardless. Alternatively, Apoquel has an on-label claim for flea allergy.

  16. My little Chinese Crested Powderful was itching the day we got her at 17 weeks. 7 days ago she received an injection of Cytopoint. All I can say is its a miracle!! No more itching!! I hope it lasts more than 4 weeks 🙂

  17. My little Westie LuLu had her first injection of Cytopoint 2 weeks ago and hasn’t scratched since! It is the first time since she was 4 months old that she has not been on Atopica or Apoquel and topped up with 3-4 x week prednisolone. She is nearly 6 years old. I had tried every dietary option too. Fingers crossed the Cytopoint lasts for at least 4 weeks.

  18. Dr Andrew. Thank you so much for the article. I know it won’t work for every furbaby but has been miraculous for my Westie. And … he can still see in the dark. I’m sure your Loki can too. lol.

  19. As a Westie owner I’ve used all of the above (I’ve had 3 A. D. Westies) over the years and no one drug suited all 3. Sadly there are always going to be people who try and scare others off from using a drug. Let them come and live with me for a day or two and see how hard it can be to care for a dog that is chronically itchy. My girls first Cytopoint lasted 5 weeks for my current lass what a huge difference it made to her itch level and the incessant licking stopped.

  20. I agree with those on FB sites who:
    1. are looking for a quick fix !, &
    2. listen to other FB members pessimistic views……Oh dear.

    I also absolutely agree with you Andrew regarding this new therapeutic treatment, Cytopoint for dogs with Atopic Dermatitis ( AD). As you are aware I also have a white dog who has seasonal AD.

    Since my boy was formally diagnosed by a Veterinarian Dermatologist with AD, I now observed when HIS cyclic seasonal triggering pollen’s commence and act I ASAP to ensure both
    our comfort.

    Besides other natural immune support supplements, (which all my 3 dogs get), only using a specific hydrating skin barrier shampoo, and Shiro’s now on his maintenance Allergen Specific Immuno-Therapy ( ASIT) injections, as discussed with the Dermatologist recently he explained how Cytopoint is antibody similar to a dogs antibody.

    I decided to switch his daily Apoquel to Cytopoint and to date he has had 3 Cytopoint injections ( 4/52, 4/52, & 5/52) with minimal post reaction and no scratching. YES for us.

    Thank you for your article on this topic.

    1. Thank you for you’d comment. I have an albino dog and she’s around 70+kgs and I think my local vet is scared of her because you guys are writing all these treatments whereas my vet just gives her a 7 day course of antibiotics so it goes away but comes back. She told me after a genealogy test that she’s albino so this will always happen but right now my girls covered in scabs, big lump rashes and small spot rashes, her nose is running like a tap, her eyes are runny and swollen, her pink skins red. So I decided to do some research on skin problems before contacting a new vet. I trusted this one to help but she will see me come in and start writing the script for antibiotics. So while I obviously can’t walk in to the next vet like I know what’s best, if I read what’s going on with other people and the options out there then if they don’t do anything I can ask about cytopoint etc.
      I don’t know what I’d do without the internet, other people have been my biggest help. People with animals in the same situation. So thank you, your comment helps people more than you’ll know

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