Treatment for canine atopic dermatitis: international guidelines summarised
Treatment for canine atopic dermatitis: International guidelines – what’s new. November 2015
Earlier this year we summarised the international guidelines on the management of canine atopic dermatitis. An updated version of the guidelines was published in August 2015. Here we summarise the main changes.
About the guidelines Definitions
The guidelines, which are published by the International Committee on Allergic Disease of Animals (ICADA), are based on a review of the published evidence on the various treatment options, from topical shampoos to oral medicines and dietarysupplements. The guidelines help by showing which treatments are supported by evidence of benefit from clinical trials.
ICADA intends to completely update the guidelines every 10 years and produce a minor update every 5 years. The most recent version is a 5-year minor update. The full version is available at Olivry T et al. Treatment of canine atopic dermatitis:2015 updated guidelines from the International Committee on Allergic Diseases of Animals (ICADA). BMC Vet Res 2015; 11: 210–15
Canine atopic dermatitis: a genetically-predisposed inflammatory and pruritic allergic skin disease with characteristic clinical features associated with IgE antibodies most commonly directed against environmental allergens.
‘Atopic-like dermatitis’: an inflammatory and pruritic skin disease with clinical features identical to those seen in canine atopic dermatitis but in which an IgE response to environmental allergies cannot be documented.
The diagnosis of atopic dermatitis relies primarily on the dog’s signalment, clinical signs and disease history, not on a laboratory test. It is based on the finding of a constellation of typical history and clinical signs with the subsequent elimination of other conditions that might mimic it.
Below we’ve summarised the main changes. And because the guidelines are international we’ve included some additional information related to UK practice.
Oclacitinib (Apoquel) was not available when the last version of the guidelines was published. The new guidelines include it as an option in the treatment of acute flares and for chronic disease. This is what they say:
- In acute flares: oclacitinib (Apoquel) can be prescribed at 0.4–0.6mg/kg orally twice daily for up to 14 days to rapidly reduce skin lesions and pruritus in dogs with atopic dermatitis. Short-term treatment with oclacitinib appears safe.(Recommendation based on consistent and good quality patient-oriented evidence) Because of theoretical concerns for a potential dose-dependent drug induced immunosuppression, the concomitant use of oral corticosteroids with oclacitinib is likely contraindicated, especially in case of infections, though such combined use has not been evaluated. (Recommendation based on consensus, usual practice, opinion, disease-oriented evidence or case series).
- In chronic atopic dermatitis: oral corticosteroids (prednisone, prednisolone or methylprednisolone), ciclosporin and oclacitinib are effective for treatment of chronic canine atopic dermatitis, concurrently with or after control of known flare factors. Oral oclacitinib should be given at 0.4–0.6mg/kg twice daily for 14 days and then once daily thereafter. (Recommendation based on consistent and good quality patient-oriented evidence). In case a complete remission of signs is obtained, further tapering should be attempted with the dose adjusted to maintain the remission of signs. (Recommendation based on consensus, usual practice, opinion, disease-oriented evidence or case series). The long-term administration of oclacitinib administered once daily appears to be relatively safe whereas the long-term safety of other dosing regimens is not known.
The suggestion to further taper the dose in case of complete remission is not a recommendation in the product’s SPC. To learn more about oclacitinib, see the module on Oclacitinib – a new treatment for itchy dogs.
Masitinib (Masivet), a protein-tyrosine kinase inhibitor used in the treatment of mast cell tumours has been added to the guidelines.
Masitinib appears to offer some benefit in dogs with chronic atopic dermatitis, but this effect must be weighed against the risk of severe renal adverse drug events that requires the performance of periodic urinalyses to detect developing proteinuria. (Recommendation based on consistent and good quality patient-oriented evidence). Masitinib might be a useful alternative for atopic dogs with signs not responding to other approved drugs. (Recommendation based on consensus, usual practice, opinion, disease-oriented evidence or case series).
Masitinib is not authorised for this use in the UK.