Cytopoint VS Apoquel for Itchy Pups

If your dog is obsessively scratching, biting, or licking itself, that's usually a red flag that it has developed a skin condition. Canine allergic dermatitis refers to itch and skin inflammation in dogs, which can be caused by food, airborne or environmental allergies.

Dogs may exhibit behavioural changes because of the pain and discomfort from their itchy skin – you might observe your pet is more lethargic or in low spirits. If left untreated, bacteria can invade the wounds caused by scratching, leading to severe skin infections.

Cytopoint and Apoquel are two potential solutions to manage itching in dogs, but many pet owners struggle to determine which is better. Understanding the differences between the two will help you decide on the best treatment option for your furry friend.

What is Cytopoint?

Cytopoint is an antibody that binds to a single specific itch-producing protein in a dog's bloodstream. Cytopoint prevents these proteins (cytokines) from binding to the skin's nerve receptors, reducing the transmission of the itch response.

What is Apoquel?

Apoquel targets inflammation at its root. It acts against specific proteins that trigger a dog's immune signalling response, blocking the production of the itch-producing cytokines in the first place. Cytopoint and Apoquel both help to reduce the circulating concentration of the itch-producing cytokine called Interleukin-31.  Cytopoint binds to the circulating chemical, knocking it out whilst Apoquel works to reduce its production.

What Are the Differences Between Cytopoint and Apoquel?

The main difference between Cytopoint and Apoquel is the method of administration and effective period. Cytopoint is an injection that needs to be taken every four weeks. Apoquel comes in the form of a pill and requires daily oral dosing.

Cytopoint and Apoquel both target itching associated with atopic allergies – which are hypersensitive reactions to typically harmless substances in the environment. They can also be used to treat itch caused by food allergies and other skin allergies.

How Do I Know Which Anti-itch Solution is Ideal For My Dog?

Apoquel is usually preferred during flare-ups of allergies. It's administered orally, via a once or twice-daily dosing. This is helpful for owners who have dogs that are difficult to bring to vets or uncomfortable with injections. As Apoquel has a short period of efficacy, it's passed out of your pet's body very rapidly. This way, owners can quickly determine if the treatment is helpful and stop it easily if needed. On the other hand, Cytopoint is injected into the skin and lasts longer on average for four weeks.

Cytopoint is ideal for dogs who are younger than one year old, have difficulty swallowing pills, or are too small for owners to accurately dose with Apoquel at home.

It's possible to use Apoquel and Cytopoint concurrently if a dog has a flare-up event and requires additional anti-itch relief.

Potential Side Effects of Cytopoint and Apoquel

Apoquel and Cytopoint are generally well-tolerated by most dogs when dosed accurately, with very few side effects. The most common side effect of Apoquel is mild gastrointestinal upset, including vomiting and diarrhoea, which tends to decrease with repeated administrations. The most common side effect of Cytopoint is lethargy within 24-28 hours after injection.

Rarer side effects of Apoquel include changes in white blood cell count and benign skin cysts. With Cytopoint, there have been certain cases in which dogs had an allergic reaction to the medicine. However, our veterinarians are able to keep an eye out and monitor the condition of your dogs, making sure that side effects are kept to a minimum.

Help Your Dog Find Relief from Itching with Mount Pleasant

Occasional itching is normal in any pet. However, if your dog is scratching and biting more than usual, it may signal a cause for concern. In these cases, it's advisable to consult a veterinary clinic like Mount Pleasant. Our experienced team can help identify the underlying causes behind your dog's allergy and discuss effective treatment options. Visit us today to ensure your precious pup gets the relief they need from that pesky itch.

FAQs Regarding Apoquel and Cytopoint

Between Apoquel and Cytopoint, Which is More Effective?

Apoquel and Cytopoint have their separate uses and there is no objective better option. Veterinarians will choose one to administer based on each individual pet's biology, medical history, and physical condition. Seek advice from a vet before moving forward with medicating your dog.

Does Apoquel or Cytopoint Get Less Effective Over Time?

A few reported cases show a decreased response with additional Cytopoint injections. Some dogs can start developing antibodies that neutralise Cytopoint, making it less effective.

However, a study conducted has shown that dogs can benefit from additional Cytopoint injections. Findings showed that around:

• 65% of dogs achieved treatment success* after the first injection
• 85% at the second, and
• 93% at the third monthly injection

The study defined treatment success as a minimum 20mm reduction in the client Pruritus Visual Analog Scale (PVAS) on the 30th day after the injection. PVAS consists of a sliding scale from 0 mm (normal dog) to 100 mm (extremely severe itch). For reference, 20 mm represents very mild or occasional itching, 40 mm mild/frequent itching, and 60 mm moderate/regular itching.

As for Apoquel, some dogs may experience an increase in the frequency of their itch when switched from twice-daily dosing to once daily. This is usually related to the short half-life of the drug (4 hours).

Additionally, while Apoquel and Cytopoint are effective for managing itchiness, they may not work if the dog has underlying infections. Conditions such as bacterial pyoderma or fungal dermatitis (Malassezia spp.), often cause these medications to be less effective, and interfere with the treatment's success.

Why Do Some Dogs Respond Better to Apoquel Instead of Cytopoint, and Vice Versa?

The exact reason has not been determined but experts in the field associate it to variances within the body’s signalling pathways and absorbance of the drug to achieve peak concentrations within the blood.

It is important to also bear in mind that attaining a 100% decrease in itch with these drugs is impossible. We like to say, if we are receiving an 80% improvement, then we are on the right track. Sometimes, we may need several medication trials.

We do know that if Cytopoint and Apoquel are going to be effective in an animal, you should be able to see its effects within the first 24-48 hours; although it may take a longer period to reach its maximum efficacy.

Are There Any Types of Dogs That Should Avoid Cytopoint and/or Apoquel?

Apoquel should be avoided for young dogs below a year old and dogs with severe infections, demodicosis, or active malignant cancer. As Apoquel modulates the immune system, it may potentially increase susceptibility to infection and worsen tumor growth.

Cytopoint is generally safe to use concurrently with other medications. However, make sure to consult your vet and bring your dog in for a checkup before administering dosages.

For some dogs, both Apoquel and Cytopoint don’t work on them. Why is this the case?

These drugs are extremely helpful to manage itch on a short and long term basis. But that does not mean flares cannot occur. In long-term allergies, dermatologists have stressed the importance of keeping infections under control. That’s because this often ends up being the reason why Apoquel or other medications might fail to work well.

Studies indicate that in dogs with atopic dermatitis, as many as two thirds will develop bacterial pyoderma and one third will develop Malassezia spp. dermatitis, also known as fungal dermatitis.

Apoquel has been criticised for preventing JAKs from doing its job, suppressing the immune system and even causing cancer and other health conditions. What is your opinion on this?

This has been quite the hot topic in the field of veterinary dermatology. There is now over 5 years of experience with the drug and a review of its safety recently showed no unexpected findings.

On cancer

If we take a step back and analyse things on a whole, the first thing we need to acknowledge is that the rate of cancer in the general dog population regardless of Apoquel usage is exceptionally high. At least higher than it is in humans. The average number stands at around 400 cases per 100,000 dogs per year. So perhaps at some point of treating a patient for a long time, there is a high likelihood that at 10 years or older, there is an almost 50/50 chance it may get cancer regardless. And most often, it is probably unlinked to any administered medication.

Recent published literature has shown that occasionally, patients have developed benign or malignant cancers, but not any higher than the normal dog population would in the age range studied. The most common cancers noted were papillomas and histiocytomas, but we also have to bear in mind that Apoquel is used in young dogs, in which these benign tumours are fairly common.

Apoquel classification

We think a lot of the concerns arise from the classification of Apoquel as an immunosuppressive drug whilst other similar human drugs fall under JAK inhibitors. When Apoquel first gained approval, the only drug class that it could be categorised under was as an immunosuppressant.

Since then, several JAK inhibitors have been approved in human medicine and established as a class on their own. Label indication for Apoquel does warn that the drug may potentiate conditions, such as cancer and precautionary monitoring is advised. These are there as a result of Apoquel’s drug classification and not because specific studies have proven that its use has a direct effect on the development of cancer. In fact, there are works to reclassify the drug from an immunosuppressant to immunomodulatory as we speak.

The goal of Apoquel is immune modulation and downregulation of the mediators of itch and skin inflammation. JAK inhibitors are extremely valuable medications in human medicine. Numerous studies launched to investigate its use so far have not provided any evidence that the use of JAK inhibitors to treat various autoimmune or immune dysregulatory diseases could contribute to an increased risk for cancer.

With all this being said, of course, it is ultimately a fairly new drug on the market and adverse reactions are still being reported as we go.