Preventing Rebound Pruritus When Initiating Oclacitinib Therapy

William Oldenhoff, DVM, DACVD, Animal Dermatology Center, Studio City, California

ArticleLast Updated May 20233 min read
Print/View PDF
image source

In the Literature 

Olivry T, Lokianskiene V, Blanco A, Del Mestre P, 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(2):99-106. doi:10.1111/vde.13134 

The Research … 

Oclacitinib is labeled for administration every 12 hours for the first 14 days, then every 24 hours thereafter; however, many dogs experience a rebound in pruritus when oclacitinib administration is reduced to once daily.  

This study evaluated whether the probability of rebound pruritus was decreased in dogs receiving prednisolone for 4 days in conjunction with the first 4 days of oclacitinib therapy. Dogs (n = 40) were randomized to receive oclacitinib (0.4-0.6 mg/kg PO every 12 hours for 14 days, then every 24 hours) either alone or with prednisolone (0.5 mg/kg PO every 12 hours) for the first 4 days of treatment. Clinicians used 2 validated scales (ie, Canine Atopic Dermatitis Extent and Severity Index [CADESI] 4, 2D-Investigator Global Assessment [IGA]) to assess response on days 0 and 28. Pet owners used the Pruritus Visual Analog Scale (PVAS) 10 and Owner Global Assessment of Treatment Efficacy (OGATE) to assess response on days 0, 4, 14, 21, and 28. Administration of other antiallergic medications (eg, systemic/topical corticosteroids, calcineurin inhibitors, antihistamines, lokivetmab) was prohibited. 

Dogs that received oclacitinib with prednisolone had significantly fewer pruritus rebounds (15%) compared with dogs receiving oclacitinib alone (45%). PVAS 10 scores were significantly lower in the prednisolone group on days 4 and 28, suggesting that dogs receiving prednisolone and oclacitinib experienced more rapid improvement in pruritus and better response over time compared with dogs receiving oclacitinib alone. Dogs that received prednisolone also had significantly lower CADESI 4 and 2D-IGA scores on day 28 and OGATE scores on days 21 and 28 compared with dogs receiving oclacitinib alone.   

Adverse effects (eg, vomiting, diarrhea, sleepiness, polyuria/polydipsia) only occurred in 6 dogs and were minor. All adverse effects resolved spontaneously without need for treatment of clinical signs or interruption of oclacitinib or prednisolone therapy. 

… The Takeaways

Key pearls to put into practice: 

  • Giving prednisolone for the first few days of oclacitinib administration may result in better clinical outcomes than oclacitinib alone. Four-day coadministration of prednisolone and oclacitinib was chosen arbitrarily; further study is needed to determine whether different durations provide better outcomes. Long-term coadministration of prednisolone and oclacitinib for treatment of allergy is not recommended and may result in immunosuppression.  

  • Both a short-term and a long-term plan are needed for allergic patients. Short-term management primarily focuses on improving patient comfort and usually involves treatment of infections and initiation of antipruritic therapy. Long-term management involves regular topical therapy, continued antipruritic treatment, and allergen-specific immunotherapy (ASIT) and is critical because atopic dermatitis is a lifelong disease.

  • Avoidance of allergens is typically ineffective or impractical. ASIT is the only treatment that can reverse the pathogenesis of canine atopic dermatitis. ASIT is formulated based on serologic and intradermal allergy tests and should be recommended for most atopic patients if the owners are amenable and able to administer the treatment.