Apoquel and steroids 1+1=3 ???

Hello, Summarians!

Spring allergy season is upon us. The first summary is a tip for those hot mess patients that may need a little extra help.

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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

Nitrofurantoin — an old new favorite?

The article discusses the use of nitrofurantoin as a treatment option for sporadic bacterial cystitis in dogs, a common condition. The most frequently isolated pathogen in dogs with cystitis is Escherichia coli. Nitrofurantoin is effective against both gram-negative and gram-positive bacteria, including E. coli. The study evaluated the pharmacokinetics of nitrofurantoin in dogs, particularly the NMM formulation. The NMM formulation has a slower absorption rate and an extended dosing interval compared to the immediate-release formulations. The study found that the NMM formulation resulted in altered plasma pharmacokinetics in dogs compared to previous reports of macrocrystalline formulations. The highest concentration observed in the plasma was far below the human breakpoint minimum inhibitory concentrations of nitrofurantoin for E. coli. Urinary concentrations of nitrofurantoin were approximately 500-fold higher than maximum plasma concentrations. The study suggests that the NMM formulation could be given at a similar dose with a less frequent dosing interval. Nitrofurantoin is an orally available, safe, and potentially efficacious option for the treatment of UTI in dogs that could result in decreased use of critically important antimicrobials. 

Meyer, E. G., Bozynski, C., Essel, L. B., Cohn, L., & Davis, J. L. (2023). Oral administration of an extended-release formulation of nitrofurantoin results in high concentrations in the urine of dogs, Journal of the American Veterinary Medical Association https://doi.org/10.2460/javma.22.12.0549 

Bottom line — Another option for larger-size canine UTIs…

Placement of Libre sensors

The article discusses the use of continuous interstitial glucose monitoring systems, specifically the "flash" glucose monitoring systems (FGMS), to monitor glucose concentrations in dogs with diabetes mellitus. The article compares the traditional location of the FGMS sensor on the dorsal aspect of the neck with an alternative location on the hip. The study found that while there was a correlation between glucose concentration readings from the two sensor locations, the hip site failed to meet ISO criteria for analytical accuracy compared to the reference standard site on the neck. However, the variation observed between the two sites was unlikely to have led to decisions that would have adversely affected the clinical outcome. Further research is needed to determine whether the FGMS hip site is capable of similar accuracy when used in diabetic, hyperglycemic dogs. 

Evans, J. B., Lidbury, J. A., Jeffery, N., Washburn, S. E., & Patterson, C. A. (2023). Hip sensor location for flash interstitial glucose monitoring system provides adequate clinical accuracy in non-diabetic hypoglycemic dogs, American Journal of Veterinary Research https://doi.org/10.2460/ajvr.23.02.0024  

Bottom line — We need to be aware of sensor placement differences

Just putting things in perspective …