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
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:
- 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!
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