Journal watch20 February 2023
Author(s): Olivry, T., Lokianskiene, V., Blanco, A., Mestre, P.D., Bergvall,K. and Beco, L.
Published in: Veterinary Dermatology
Date: November 2022
DOI: https://doi.org/10.1111/vde.13134
Type of access: Open access
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Our summary
Olivry, T. et al. (2022) 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. Veterinary Dermatology.
The aim of this randomised controlled trial was to determine whether an initial four-day course of prednisolone at the start of oclacitinib therapy, would reduce pruritus rebound in dogs, one week after decreasing the frequency of oclacitinib administration.
Dogs with atopic dermatitis (AD) were randomly allocated equally into two groups: the oclacitinib monotherapy (OM) group (oclacitinib dosage of 0.4-0.6 mg/kg, twice daily for 14 days, then once daily for 14 days) and the prednisolone-oclacitinib (PO) group (prednisolone dosage at 0.5±0.2 mg/kg twice daily for first four days, concurrent with oclacitinib as for OM group).
Skin lesions were graded by veterinary surgeons using the Canine Atopic Dermatitis Extent and Severity Index (CADESI4) before treatment (D0) and four weeks later (D28), the erythema grade of the CADESI4 was extracted and reported using CADESI4-E. The overall severity of the AD skin lesions was graded using the 2D-Investigator Global Assessment (IGA) scale.
Owners were asked to assess the level of pruritus using a Visual Analog Scale during the 24 hours preceding and then again on D4, D14, D21 and D28 along with scoring their perception of the efficacy of treatment.
Forty dogs were included in the study. There were significantly fewer cases of rebound pruritus in the PO group (15%) compared to the OM group (45%) at D21. Comparing pruritus scores at each re-evaluation point the scores in the PO group were significantly lower than those in the OM group on D4 and D28. Skin lesion scores ( CADESI4, CADESI4-E and 2D-IGA) were significantly lower for the PO group on D28. On D21 and D28, the owner assessment (OGATE) scores were higher for the PO group, and a significantly higher proportion of dogs in the PO group were classed by their owners as having a ‘good’ or ‘excellent’ response to their treatment.
Reported adverse events were few in number and considered minor or intermittent, all resolved naturally.
Limitations of the study are the small number of dogs involved, the short duration of the trial and the lack of blinding of the treatments.
Take home
This study provides some evidence that a four day course of prednisolone in addition to oclacitinib improves initial reduction in pruritus and reduces rebound pruritus when the oclacitinib dose is reduced.
The following may also be of interest
Olivry, T. et al. (2015) Treatment of canine atopic dermatitis: 2015 updated guidelines from the International Committee on Allergic Diseases of Animals (ICADA). BMC Veterinary Research, 11, no. 210. https://doi.org/10.1186/s12917-015-0514-6
Nuttall, T.J. et al. (2019) Update on pathogenesis, diagnosis, and treatment of atopic dermatitis in dogs. Journal of the American Veterinary Medical Association, 254 (11) , pp. 1291-1300. https://doi.org/10.2460/javma.254.11.1291
Cheung, B.Y.T. (2022) In dogs with atopic skin disease, is lokivetmab more effective than oclacitinib in reducing the score of a recognised scoring system? Veterinary Evidence, 7 (2). https://doi.org/10.18849/ve.v7i2.569
Long, S. (2020) Managing atopic dermatitis in dogs: are antihistamines as effective as glucocorticoids? Veterinary Evidence, 5 (4). https://doi.org/10.18849/ve.v5i4.335
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