Dr. Plant will be in Valencia, Spain from September 17-22, while attending the European Society of Veterinary Dermatology Meeting, where he will present research findings and participate as a member of the International Committee on Allergic Diseases of Animals, a group of 25 experts from around the world. We will only see patients on Monday, September 16 that week, so plan ahead if you foresee the need for an appointment.  We will be open our normal hours for questions and medication refills. 

Dr. Plant's research is entitled "Reproducibility of allergen-specific IgE assays and ensuing immunotherapy recommendations from four laboratories."  The study found that the agreement between the four allergy testing laboratories was only slightly better than could be expected by chance alone. The finding is not surprising, but the poor agreement is now documented. The fact that we can't tell you whether one lab's results are more accurate than another is one of the main reasons that Dr. Plant no longer recommends these assays. 

The new oral drug, Apoquel®, was developed specifically for the treatment of allergies in dogs by Zoetis, formerly Pfizer Animal Health. It is meant to take the place of drugs like prednisone, Temaril P, antihistamines, and Atopica®.  Each of these drugs has limitations in terms of cost, effectiveness, and/or safety. Apoquel can be used in conjunction with immunotherapy, which remains the only treatment that can address the underlying cause of dogs' allergies, making them more tolerant of allergens.

Although Apoquel will not be widely available to primary care veterinarians until 2014, we at SkinVet are scheduled to receive the first shipment in October as part of a program to get the limited supply of medication to the pets that need it most. The pricing has yet to be announced by Zoetis, so I can't provide any concrete information. All indications are that it will be priced lower than Atopica.

The drug has a unique mechanism of action, inhibiting both inflammation and the itch sensation. It works more quickly than cortisone (steroids like prednisone and dexamethasone), is equally effective, and has fewer side effects. During the FDA-approval process, it was been given to over 1,000 dogs in various clinical studies, with long-term follow-up of several years on many of those dogs. It was found to increase the incidence of demodectic mange in dogs less than one year of age, so it is not approved for younger dogs. Other side effects seem to be uncommon. But, as a new drug that effects a specific target of the immune system, we will want to monitor patients that take Apoquel for side effects.

Normally, at the end of a drug trial, the medication is not available until the FDA approves it.  In the case of Apoquel, so many pet owners and veterinarians who participated in the clinical trials wrote to Pfizer pleading to continue with the medication that the FDA relented and allowed Pfizer to continue supplying the test drug while it was under consideration. Judging by some of those letters that Pfizer has shared, Apoquel had a profound effect on the quality of life of many dogs.  I hope that it lives up to the data presented in the studies and presentations that I have seen thus far.

We've already identified some of our most "skin-challenged" patients as the first dogs that will start on Apoquel in our clinic. If you would like us to contact you when we have Apoquel in stock, send us an email (info@skinvetclinic.com) and we will add your dog to the list of candidates. Once we receive Apoquel, we will contact you to schedule a consultation.

Sorry, there is no information on the use of Apoquel in cats available.

Here are some links to additional information about Apoquel:

Published efficacy and safety study:

http://onlinelibrary.wiley.com/doi/10.1111/vde.12047/pdf

Press release:

http://news.zoetis.com/press-release/companion-animals/fda-approves-apoquel-oclacitinib-tablet-control-itch-and-inflammatio

Package insert:

www.apoquel.com