Apoquel: a miracle drug with a Dark Side

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Apoquel: a miracle drug with a Dark Side

June 11, 2016

Apoquel: Dog Miracle Drug With a Dark Side

Darkness dog howl

A-wooo! Click Here for Alternatives to Apoquel

Part One: A New Wonder Drug for Itchy Dogs?

When you have a crazily itchy dog or cat, I really feel for you. Patients in this state often keep you up at night and drive you crazy dealing with the mad itch during the day.

Scratching, biting, losing hair, often with red, irritated, inflamed skin, these guys often stink, ooze sticky moisture from their skin, and many can’t get comfortable long enough to take a decent nap, let alone sleep the night through.

At the base of wildly itchy animals is the immune system, which is working overtime, is asleep at the switch, or is malfunctioning.

“Dysregulated” is a term used in the scientific papers.

(We have to insert a wink here, because immune system dysregulation is entirely a manmade disease, but more on that later. Interestingly, most look right past that important point and seek to “fix” it with powerful drugs.)

The latest anti-inflammatory drug to make a splash in the veterinary market is Apoquel(oclacitinib). Born from the loins of the world’s largest drug maker Pfizer, their former division Zoetis is now the “animal health” giant that brought this much touted wonder drug to market in 2014.

How big is Zoetis? $4.34 billion in revenue in 2012, before Apoquel had even hit the market.

So: BIG.

Stops Itch FAST!

The claims, and even the actual results in itchy dogs, are amazing.

Provides onset of relief within 4 hours. Effectively controls itch within 24 hours.”

Irresistible, right? After you’ve lost sleep for weeks on end and tried everything offered you by Dr. WhiteCoat and Dr. Google without success, wouldn’t this sound like heaven in a pill?

Apoquel sold like hot cakes when it first appeared. Interestingly, there was quickly a shortage in supply, so the demand was heightened even further, as desperate dog owners sought vets who had some.

“We’ll buy any size you’ve got, we’ll cut the giant breed size to work for our Chihuahua, we just NEED TO GET THIS ITCH UNDER CONTROL!”

One might surmise that shortage was intentional, but that’s beyond the scope of this article.

The company’s research and the experience of many dog owners corroborate this: this wonder drugs stops itching almost immediately.

How Does Apoquel Work?

Ah, now you’re asking a smart question. Pull up a little closer to the campfire for this part, because here’s where the story gets good.

To know how the drug works, you should know first how The Itch works.

Here’s what a board certified veterinary dermatologist says causes The Itch:

  • Flea allergy dermatitis
  • Atopic dermatitis
  • Food allergy dermatitis
  • Contact dermatitis
  • Sarcoptic mange
  • Demodectic mange

I really, really wish I was making this up. But, while that explanation should leave you speechless, the part he does get right is this:

Itchy, allergic dogs are the #1 reason pets go to vets.

Remember that wild and crazy immune system, spoken of earlier? The one that’s off the rails, acting all whacky and dysregulated? That’s what Apoquel is acting on. It’s being called an “immune modulator” by the experts.

In Part Two, I go into how that dermatologist really missed the larger point of what causes itch. And how to work to truly prevent this maddening disease from wreaking havoc on your own animals. As you might guess, prevention in a real sense will trump giving a drug to try to control this painful disease.

For now, here’s a brief description of how this wonder drug works.

Immunology 101

First, an important understanding. While it might seem like we know a lot about the immune response, there are still large swaths of mystery we don’t yet comprehend. By its very nature, this is one complex system! If we didn’t have it, we’d have been lost as a species a very long time ago, right along with our pets and our livestock.

That said, we know there are lot of messenger molecules involved. And sweeping events called cascades, where the right trigger (a virus, say) causes a series of chemical messages and events that, when all is working well, keeps us and our animals out of harm’s way.

We Need to Talk

One group of immune messengers are called cytokines. These small molecules are produced by a wide variety of cells, and they signal other cells to do something, like come to the scene of an infection, let loose their chemicals, take part in signaling others, dump antibodies, etc.

You’ve likely heard of some cytokines before.

  • Interferon
  • Interleukins
  • Tumor necrosis factors

When inflammation is triggered, these chemical messengers call in the troops. It’s time to heal!

(More on inflammation in context here. It’s not the enemy, by the way.)

Enter Apoquel (Oclacitinib)

A couple of words hidden in those names. A whole class of inhibitory compounds man has invented have “inib” at their end. Short for inhibit. And “quel?” You get that one.

Chill out this hot mess of inflammation!

So, this drug seeks to stop a piece of the inflammatory chemical cascade by interfering with certain enzymes called kinases, or JAK in the literature, which stops some cytokines from doing their thing.

And it works! But like all things that work, we need to look a bit deeper if we want to raise truly Vital Animals. (See Just Gimme What Works! for more on this).

Usually, there’s a price to pay in long term health when we interfere with Mother Nature, and this drug is no exception.

Long Term Safety? Not So Much.

My Texas colleague Dr. Ron Hines has done a brilliant job of cataloging feedback from animal owners actually using this drug.

When you read past the glowing reports of “Hallelujah! Peace at last!” you start to pick up a theme.

Those who’ve been using this drug long term are seeing two common problems. Variations of these occur in most all drugs, in fact, not just this one:

  1. Side effects
  2. No longer helping as much as it did at first.

Here are a few real people, real dog problems I highlighted. You’ll see more if you dig further.

[8 months on the drug, Bishon] The drug has given my dog (four years old) a quality of life I never thought was possible. He also receives an allergy serum injection every ten days. However, for the past several weeks his nose has been running constantly and as of late he has been gurgling rather than breathing. Two days ago, his nose was bleeding. I stopped the Apoquel immediately and will see the allergist this week. Most importantly, two days after I stopped the Apoquel, his nose dried up, no more running and no more blood. I cannot help but assume that the Apoquel was the cause of his misery.”

[6 mo. on the drug, Mini Dachshund] She has gained almost 3 pounds, and has become very yeasty and smelly. She also has pain going down stairs and playing. In reading about Xeljanz (a human variation of Apoquel) in an advertisement in a magazine, I noted that this drug is an immunosuppressant. Yes it works for the itching, but I am concerned about the changes in her health since taking this drug.”

[1 year on the drug, Mini Schnauzer] Curly has just been discharged after 4 days in the hospital. He was hospitalized due to a mysterious 105ºF fever, lack of appetite, huge papilloma lesions in his mouth, vomit,and abdominal pain… It worked only in the beginning, and now it barely provides some mild relief to his itch; he chews his paws raw and now his face and legs and tummy itch a lot, too…
So here is our challenge: It seems that Apoquel has greatly contributed to weaken Curly’s immune system to the point that his platelets and also his red blood cell count is considerably low. At the same time, he is experiencing very little relief by taking it. The internist believes that continuing the Apoquel any further (would) wreak havoc in his immune system, that we can only expect more papilloma lesions, further inflammation of his lymph nodes, lower platelet cell cell count and so on.”

Also of note, this drug is not labeled for cats. Or pups under 12 months old. Hmmm. What are they telling us in between the lines here?

Too Good to Be True? I’d Put Money On It.

So, a big caution here, as with all “miracle” drugs. If it’s interfering with your dog’s immune system, and running out of gas after a certain period of use, is there any hope that it will cure your dog’s itch?

Of course not. As you’ve learned, if you’ve followed along for any length of time, drugs never cure chronic disease. They cannot.

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