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Cytopoint vs Apoquel Pros & Cons for Skin Allergies in Dogs

Dog skin allergies are a very common problem that drives millions of dogs and owners crazy every year. Today, I’ll discuss two newer therapies and compare Cytopoint vs Apoquel.

The latest understanding of allergic skin disease in dogs is that it is a vicious cycle of inflammation and itch. 

It goes something like this:

Dog comes in contact with allergen (pollen, etc.)>>Immune system responds by producing inflammatory substances>>inflammation disturbs the skin barrier>>Nervous system responds and produces an itch sensation>>dog scratches and causes more inflammation>>more itch… and so on. (9) 

Cytopoint®(lokivetmab) and Apoquel® (oclacitinib maleate) are newer therapies to treat dogs with atopic dermatitis. Both reduce allergic itch by blocking an itch-promoting substance (interleukin-31) but they work in slightly different ways. 

Cytopoint is an injection given by a veterinarian every 4-8 weeks while Apoquel is an oral tablet a pet owner gives daily at home. Cytopoint is not a drug, per se, while Apoquel is considered to be a drug. Both work well to stop allergic dogs from feeling so itchy. Both have a low incidence of side effects. 

But there are some important things you should know before deciding which is best for your dog.

What Is Cytopoint?

Cytopoint is a medication given by subcutaneous injection to reduce inflammation and itching in dogs with allergic skin disease. The generic name of the product is lokivetmab and it’s made by Zoetis. The product was approved by USDA and introduced for widespread use in the United States in 2016. 

Cytopoint uses a monoclonal antibody produced using genetically engineered hamster ovary cells (5). The antibody is “caninized” to bind to and block interleukin-31, a substance produced in a dog’s body that is involved in the itch sensation (6). So, Cytopoint is an antibody that binds interleukin-31 to keep it from signaling cells to make more itchy substances.

This is amazing technology! Scientists figured out how to make hamster ovary cells produce an antibody that destroys an inflammation-promoting substance. And they modified it to work against the specific inflammation-promoting substance produced in a dog’s body. 

What Is Apoquel?

Apoquel is a medication administered orally in tablet form to dogs to control itch and allergic dermatitis. The generic name is oclacitinib maleate and this med is made by the same company as Cytopoint (Zoetis). 

Apoquel produces a similar result, but by a different method. Janus kinase (JAK) is a cell-signaling enzyme in a dog’s body that helps make more inflammatory substances. Apoquel is a JAK inhibitor and works less specifically than Cytopoint by modulating the production of interleukin-31 as well as interleukin-2,-4,-6 and 13. In essence, Apoquel blocks a dog’s cells from making interleukin-31 (as well as 4 other interleukins). 

The United States’ FDA approved this drug for veterinary use in 2013. 

Apoquel has commonly been used in place of steroids like prednisone, to help allergic dogs. The revolutionary thing about it is that it doesn’t cause the annoying side effects we see with steroids, namely excessive drinking, urination and appetite.

Vets also like the fact that it can be given long or short-term and that most dogs don’t experience any adverse effects from it. 

Which Is Better for Dog Allergies: Cytopoint or Apoquel?

Cytopoint and Apoquel are both effective at reducing skin allergies symptoms in dogs (7,8). But each one is suited to certain dogs and certain dog owner preferences. 

I’ve pored over the research, manufacturer statements and package inserts for both therapeutics and made a list of pros and cons so you can more easily compare Cytopoint vs Apoquel. 

I’ve highlighted in red the pros and cons that I think would be most important to dog owners. Please keep in mind, this information is my professional interpretation of the data and not a guarantee from me or the manufacturers.

Cytopoint Pros and Cons

ProsCons
Use in any age dogDoesn’t work for every dog .
Works to reduce itching (pruritus) in at least ⅔ of treated dogs.
No pilling required.Requires a trip to see your veterinarian.
OK to give with other medication including prednisone, antibiotics, NSAIDs, vaccines.Side effects are not common but could include:  lethargy, vomiting, hyperexcitability, pain at the injection site and urinary incontinence.
Can be used short- or long-term.Effects may start to wear off after a few weeks, requiring another trip to the vet for another shot.
Effects of a single shot last “at least 1 month” according to manufacturer.Can’t be administered more frequently than ever 4 weeks, so if it wears off a bit early you may need to give other meds to control itching.
Prevents skin allergy flares when given at the right time. (8)
Works to reduce itchy skin within 24 hours.Once the injection is given, there is no way to “un-give” it if your dog has a problem with it. Stays in the system for 4-8 weeks. 
Can help dogs who have both skin and food allergies. Stops working for some dogs after an initial positive response.
Non-drug therapy for treating skin allergies.May take multiple injections to a reduction in allergic dog itch.
Not known to cause problems in dogs with cancer or systemic fungal disease like Valley Fever. (Doesn’t suppress the immune system).May be considered an unnatural manipulation of body functions by some people.
Veterinarians find it helpful in dogs more prone to experiencing side effects from any medication.Should be avoided during food allergy trials because it reduces itching and you won’t be able to gauge response to food.
A Cytopoint injection may provide itch relief in some cases when Apoquel does not.

Apoquel Pros and Cons

ProsCons
No trip to see a veterinarian is required after the first one (and periodic re-checks). You can give it when your dog needs it and discontinue after his allergy season ends. Comes in a pill form that must be given orally once or twice a day. Some dogs hate taking pills!
Works to reduce itchy skin within 4 hours.Should not be used in dogs less than 1-year-old.
Reduces both inflammatory substances AND direct itch-causing substances.Increases chances of serious infections. 
Effective in treating itch and allergic dermatitis in at least ⅔ of treated dogs.Not every dog has a good response.
Labeled to treat not only atopic dermatitis, but also flea allergy, scabies, and food allergy-related pruritus.May cause existing cancers to get worse. May be associated with new benign and malignant growths.
May work for dogs when Cytopoint does not.The most common side effects are vomiting, diarrhea, lethargy, anorexia, and bloodwork changes (liver enzyme elevation). 
OK to use with immunotherapy (allergy shots), NSAIDs, antibiotics and vaccines.Has not been tested for use with systemic immunosuppressants, such as corticosteroids and cyclosporine.
OK to use short- or long-term.Can increase severity of pre-existing parasitic infections including Demodectic mange. 
Not for use in dogs with serious infections.
Immune system modulator–may cause unwanted effects.

My Personal Experiences with Apoquel and Cytopoint

Both of the dogs I have currently suffer from skin allergies during part of the year. One of them had it bad enough that I did allergy testing then treated her with immunotherapy when she was just a few years old. She doesn’t have very bad allergy issues anymore and I can control her symptoms with bathing and topical products.

My other dog started out with mild allergic dermatitis but got worse over the years. I was able to get him through the worst of his allergy season with a little bit of steroid for a couple of weeks. 

Then the poor old guy started suffering from arthritis pain so I gave him carprofen. It works well for his pain, but you can’t give steroids to a dog who is taking carprofen.

cytopoint vs apoquel for dog licking his paws
My dogs feet losing hair from him licking during the spring.

Each spring, his skin symptoms got worse despite my efforts and I had to resort to giving him Apoquel. It controlled his itching very quickly! After the initial twice a day regimen, he did well taking the medication only once a day.

I don’t know why, but this dog is pretty sensitive to all medication. For example, he had a seizure after taking a CBD supplement and after taking a muscle relaxer!

Not surprisingly, the Apoquel seemed to messed up his guts. After taking it for a few weeks he started getting diarrhea when he had never had bowel problems in his whole life.

It took a while for his guts to go back to normal after he finished the prescription. I had to give him multiple rounds of probiotics and even some metronidazole before things calmed down for good.

I’ve never treated him with Cytopoint, but I’m considering using it in the future. With its low incidence of side effects, I think it might be a good option for my very sensitive dog. 

I’ve prescribed Cytopoint injections for many dogs in the clinic and most of them have responded very well. But there are always a few that don’t get any relief after getting the injection. 

Summary and FAQs

What Are The Differences Between Cytopoint and Apoquel?

Cytopoint is an injection while Apoquel is an oral medication. Cytopoint directly disables an itch-causing substance while Apoquel stops cells from producing itch-causing substances.

Are Cytopoint or Apoquel Steroids?

Neither of these newer dog allergy medications is a steroid (like prednisone). Cytopoint and Apoquel do not cause the same side effects that prednisone causes (increased drinking, urinating, appetite, weight gain, etc.).

Side Effects of Cytopoint and Apoquel

The most common side effects of Cytopoint are temporary vomiting, diarrhea and lethargy. Apoquel’s most frequent side effects are transient vomiting, diarrhea and poor appetite. Side effects are infrequent for both medications. 

How Long Does It Take Cytopoint and Apoquel to Work?

Cytopoint injections start to reduce itching symptoms within one to three days in most dogs. An itchy dog taking Apoquel usually has a reduction in symptoms within several hours.

How Frequently Can Cytopoint and Apoquel Be Used?

Cytopoint injections can be given every four to eight weeks. Apoquel is given twice a day for up to two weeks, then once a day after that. 

Both medications can be used intermittently or long-term, depending on each dog’s needs. 

Cytopoint vs. Apoquel Cost

While costs will vary by region, I’ve found the cost of Cytopoint injection and Apoquel tablets are similar for a given period of time. 

For my own dog, it costs about $100 to treat a 50-pound dog with Apoquel for one month when bought from a discount online pharmacy. A Cytopoint injection for him costs approximately 25-30% more. Don’t forget that your vet may require exams to get refills on Apoquel or additional Cytopoint injections so you could end up spending more.

But you should check with your vet how much each would cost for your dog. In some clinics, Cytopoint is more cost-effective than Apoquel for larger dogs. 

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References

  1. Apoquel. Zoetis Petcare. (n.d.). Retrieved September 23, 2021, from https://www.zoetispetcare.com/products/apoquel. 
  2. Apoquel Prescribing Information (package insert). www.zoetisus.com. (n.d.). Retrieved September 23, 2021, from https://www.zoetisus.com/products/dogs/apoquel/assets/downloadable-resources/apoquel_prescribing_information.pdf. 
  3. CYTOPOINT: Canine atopic DERMATITIS Immunotherapeutic (cadi) injection: Zoetis US. Zoetis. (n.d.). Retrieved September 23, 2021, from https://www.zoetisus.com/products/dogs/cytopoint/. 
  4. Cytopoint Approved Package Insert. www.zoetisus.com. (n.d.). Retrieved September 23, 2021, from https://www.zoetisus.com/products/dogs/cytopoint/assets/resources/2019/cytopoint-approved-package-insert.pdf. 
  5. European Medicines Agency. (2017, February 16). Committee for Medicinal Products for Veterinary Use (CVMP) CVMP assessment report for CYTOPOINT (EMEA/V/C/003939/0000). EMA Europa. Retrieved December 24, 2021, from https://www.ema.europa.eu/en/documents/assessment-report/cytopoint-epar-public-assessment-report_en.pdf 
  6. Gonzales, A. J., Humphrey, W. R., Messamore, J. E., Fleck, T. J., Fici, G. J., Shelly, J. A., … & McCall, R. B. (2013). Interleukin‐31: its role in canine pruritus and naturally occurring canine atopic dermatitis. Veterinary dermatology, 24(1), 48-e12.
  7. Lee, S., Yun, T., Koo, Y., Chae, Y., Lee, D., Choi, D., … & Kang, B. T. (2021). Clinical Efficacy of Oclacitinib and Lokivetmab in Dogs with Canine Atopic Dermatitis. Journal of veterinary clinics, 38(3), 127-134.
  8. Marsella, R., Ahrens, K., Wilkes, R., Trujillo, A., & Dorr, M. (2020). Comparison of various treatment options for canine atopic dermatitis: a blinded, randomized, controlled study in a colony of research atopic beagle dogs. Veterinary dermatology, 31(4), 284-e69.
  9. Marsella, R., Sousa, C. A., Gonzales, A. J., & Fadok, V. A. (2012). Current understanding of the pathophysiologic mechanisms of canine atopic dermatitis. Journal of the American veterinary medical Association, 241(2), 194-207.
  10. McKay, L. (2017, July 12). Making a difference for dogs with atopic dermatitis: When to Use apoquel and when to USE CYTOPOINT. DVM 360. Retrieved September 23, 2021, from https://www.dvm360.com/view/making-difference-dogs-with-atopic-dermatitis-when-use-apoquel-and-when-use-cytopoint. 
  11. Souza, C. P., Rosychuk, R. A., Contreras, E. T., Schissler, J. R., & Simpson, A. C. (2018). A retrospective analysis of the use of lokivetmab in the management of allergic pruritus in a referral population of 135 dogs in the western USA. Veterinary dermatology, 29(6), 489-e164.