1 Year Greatets Hits

Hello, Summarians!

It’s our 1 year anniversary. In honor of that, we are publishing some of the highlights from the past 12 months. I hope you enjoy them

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If it is valuable to you please consider sending it on to a friend 😄 

Apoquel and steroids

Oclacitinib is a JAK inhibitor approved for the treatment of canine allergic and atopic dermatitis (AD). However, reducing the frequency of administration of oclacitinib after two weeks was associated with an unexpected increase in pruritus, referred to as the rebound phenomenon. The hypothesis for this rebound is that oclacitinib only blocks intracellular signaling of JAK-dependent cytokine receptors without inhibiting the production and release of pro-allergic cytokines, which could result in the activation of sensory neurons and itch. The addition of steroids during the induction phase of oclacitinib therapy may prevent an increase in cytokine secretion and reduce the probability of rebound pruritus. This RCT tested the hypothesis that a 4-day course of prednisolone at the onset of oclacitinib therapy reduces the proportion of atopic dogs exhibiting a rebound in pruritus. The trial found that the adjunctive glucocorticoid therapy led to a significant reduction in the frequency of rebounds of pruritus by two-thirds. Furthermore, the addition of glucocorticoids resulted in a greater reduction of owner-rated pruritus and veterinarian-evaluated skin lesion scores, as well as a better perception of the benefit of oclacitinib therapy. The trial documented intermittent adverse events, but they were mild, intermittent, and spontaneously resolving. The trial's limitations included its short duration, small number of dogs, and lack of blinding and masking of the intervention. However, the trial's results suggest the likely superior benefit of adding a short course of glucocorticoids when starting oclacitinib therapy. 

Olivry, T, Lokianskiene, V, Blanco, A, Mestre, PD, Bergvall, K, Beco, L. A randomised controlled trial testing the rebound-preventing benefit of four days of prednisolone during the induction of oclacitinib therapy in dogs with atopic dermatitis. Vet Dermatol. 2023; 34: 99– 106. https://doi.org/10.1111/vde.13134

Bottom line — Suggests that combo therapy may be beneficial

Multi-dose Vial Sterility of Insulin

The study aimed to assess the sterility of refrigerated multi-dose insulin vials over a period of six months during which they were routinely used. The research included two types of insulin: insulin glargine U100 with metacresol and protamine zinc insulin U40 with phenol as preservatives. Each day, twice a day, the vials were aspirated using new syringes. To evaluate sterility, half of the vials were wiped with an alcohol swab before insulin was drawn. 

Throughout the study, 454 samples were taken and cultured. Only one sample showed growth of Staphylococcus epidermidis, which was not repeated in subsequent tests. This particular vial was later removed from the study due to accidental breakage. No other vials showed signs of microbial contamination. 

The findings suggest that using refrigerated multi-dose insulin vials for up to six months does not pose a significant risk of infection to patients, even when an alcohol swab is not used before each aspiration. This implies that the preservatives in the insulin are effective in maintaining sterility over an extended period of regular use. 

Berg AS, Jacob ME, Mamo LB, Pluta DH, Lunn KF. Refrigerated multi-dose insulin vials remain sterile through 6 months of use. J Small Anim Pract. 2023 Aug 9. doi: 10.1111/jsap.13664.  PMID: 37559404. 

Bottom line — The preservatives seem to be working during the 6 month time frame.

ADHD vs Separation Anxiety in Dogs.

ADHD is a highly heritable neurodevelopmental disorder with a global prevalence of 2-7% in humans. It is characterized by persistent and inappropriate levels of motor overactivity, impulsivity, and inattention, resulting from abnormalities in various cognitive processes. ADHD can manifest in different presentations, including hyperactive/impulsive, inattentive, or combined types, and often persists into adulthood with various comorbidities. Impulsivity, a component of ADHD, is characterized by impaired motor inhibitory control and an inability to tolerate gratification delay. High levels of impulsivity are associated with detrimental behaviors in various species, including humans, rodents, and dogs. The under-recognition of ADHD in humans hinders its management, partly due to the lack of suitable animal models. Dogs, with approximately 12-15% displaying high hyperactivity/impulsivity and 20% exhibiting inattention, offer a potential animal model for ADHD. Dogs and humans share behavioral, biological, and genetic factors related to these traits, and dogs respond to ADHD medications used in humans. To study ADHD in dogs, objective and reliable phenotyping methods are essential. Owner-filled questionnaires, like the one developed by Vas et al., provide a reliable way to measure hyperactivity, impulsivity, and attention in dogs. This questionnaire was recently validated and linked high impulsivity and inattention scores to lower cognitive task performance. This study involved over 11,000 Finnish pet dogs, aiming to identify demographic, environmental, and behavioral factors associated with canine hyperactivity/impulsivity and inattention. It found several factors influencing these traits, including age, sex, body size, breed, exercise, training, and time spent alone. Some breeds displayed higher levels of hyperactivity/impulsivity or inattention, likely due to selective breeding for specific behaviors. The study also uncovered comorbidities between hyperactivity/impulsivity and inattention and other behavioral traits, such as compulsive behavior, aggressiveness, and fearfulness in dogs. These findings parallel the comorbid associations observed in human ADHD with conditions like autism, anxiety, and mood disorders. Overall, this research suggests that different breeds of dogs could serve as models for various presentations of ADHD. Canine hyperactivity/impulsivity and inattention have strong genetic components and share neurobiological pathways with human ADHD. The study highlights the dog as a valuable model for ADHD research due to its genetic, physiological, and environmental similarities to humans, offering insights into both canine behavior and human ADHD research. 

Sulkama, S., Puurunen, J., Salonen, M. et al. Canine hyperactivity, impulsivity, and inattention share similar demographic risk factors and behavioral comorbidities with human ADHD. Transl Psychiatry 11, 501 (2021). https://doi.org/10.1038/s41398-021-01626-x 

Bottom line — Better recognition of this may help with early intervention and better outcomes clinically

Just putting things in perspective …