“Ask a Vet” Question About Cytopoint vs. Apoquel
“Our Black Labrador has been diagnosed with allergies to pollen and nothing we have tried so far seems to help him much. Our vet recommends Apoquel or Cytopoint but we have not yet been able to decide. Can you provide your insights on Cytopoint vs. Apoquel and tell us what you think?”
Answer: Apoquel and Cytopoint Work Quite Differently
Let’s break it down. Below is a comparison of the two medications, the potential problems with each, and some alternatives you may want to consider in caring for your Lab’s allergies.
What Is Apoquel?
Allergies are a type of overreaction by your dog’s body. In this case, it is a reaction to pollen in the environment. Apoquel works by causing the immune system to work less efficiently and not overreact to the pollens he is allergic to.
Potential Problems With Apoquel
- It comes with possible side effects
- It may worsen pre-existing cancer
- The cost is high
1. Apoquel Comes with Possible Side Effects
The first problem is the side effects. The company that manufactures and sells this medication justifies its use by pointing out that over 90% of dogs taking this medication for their allergies have an improved quality of life. (1) Estimates vary but at least 5% of dogs end up much worse, with recurrent bladder infections, ear infections, serious skin infections, and vomiting and diarrhea. There is no way to predict if your Lab will fall into the 90% or the 5% column.
2. It May Worsen Pre-Existing Cancer
The second problem after infections is the possibility of cancer. Apoquel will not cause your dog to get cancer. But even according to the company that sells the product, it will cause any pre-existing cancers to get worse. We do know that your dog’s immune system removes cancer cells constantly, probably every day, so if the immune system is depressed this is less likely to happen. Labrador Retrievers are more likely to develop lymphoma than many other dog breeds so you will have to decide whether the chances of his coming down with cancer is worse than his allergies.
3. The Cost of Apoquel Is High
The third problem with Apoquel is that it is quite expensive. The cost can be significant if you choose to keep a dog as large as a Lab on a maintenance dose.
What Is Cytopoint?
This medication does not suppress the immune system like Apoquel. It does affect the immune system but is considered a modulator, not a suppressant. Cytopoint works on the immune system by blocking one of the chemicals that can lead to itching when exposed to allergens. One study found an 87.8% response rate but another study of dogs with moderate itching reported a 98% response within a month. (2)
Potential Problems With Cytopoint
- Autoimmune disease risk (and underreporting)
- Possible side effects
- High-cost factors to consider
1. Autoimmune Disease Risk & Underreporting
The first problem with Cytopoint is just based on anecdotal reports. It may be causing autoimmune diseases like pemphigus and lupus in some dogs but those animals have not been studied and no reports have been published. Estimates vary but one survey of human drugs estimated that only about ten percent of adverse reactions are even reported. That is probably even less in dogs and there is no reason for the manufacturer to investigate them. Veterinarians are usually told that it is a pre-existing condition.
2. Cytopoint Possible Side Effects
The second possible problem is with Cytopoint and all injectable drugs, even vaccines. They all can cause side effects. The side effects seen with a Cytopoint injection include:
- Injection site pain and swelling: There are no good estimates for how long this drug is going to be in your dog’s body. The half-life of the antibody in the injection has been reported to be about 16 days, (3) so every day, the amount in the body goes down a little. It stops working in most dogs in about 4 to 8 weeks, but just because it does not work anymore does not mean it is not present. After about 3 months, your dog will still have at least 1.5% of the drug in her body.
- Allergic reaction: As with any foreign substance injected into the body, Cytopoint can cause an allergic response. Dogs can develop hives, have a swollen face, or even collapse and not be able to breathe.
- Vomiting and diarrhea
- Decreased appetite
- Lethargy
- Seizures: This is a rare adverse event but it is one reason it is not used in some dogs.
- Ataxia
High-Cost Factors to Consider
The last possible problem is the cost. If you compare Cytopoint vs. Apoquel, Cytopoint is not usually as expensive as buying a bottle of Apoquel. But since you will have to take your dog to the vet every time he needs an injection it can end up being just as much. You will be looking at the cost of an office visit and, for a dog as large as a Labrador, at least $150 for the Cytopoint injection.
What Does Dermatitis Caused by Allergies Look Like in Dogs?
Below are a few pictures of skin irritation (dermatitis) caused by inhalant allergies, such as pollen or dust, in Black Labrador Retrievers.
Alternatives to Apoquel and Cytopoint
Before considering either of those medications I think you need to look at all of the alternatives and see if there is something you need to try:
Reduce Allergen Exposure
This is something you can do immediately at home. If your dog also shows signs after he runs in a field, do not let him out. If he has signs year-round and is an inside dog, it is not just pollen to blame. You can reduce the allergens in the house by changing your HVAC filters, vacuuming more frequently, getting rid of your house plants, and changing your carpet for a hardwood floor. If your Lab only has seasonal allergies it is a good idea to keep him in when the pollen counts are high and use air filters when he is inside.
Prescription Flea Control
Even one flea bite can cause intense itching in an allergic dog. Since your dog is already allergic to pollen, a problem like a flea bite can cause severe symptoms.
Fish Oil
Omega 3 fatty acids have been proven to control mild itching in dogs. I prefer to add this as part of a dog’s diet (sardines or fresh fish) but if you want to purchase a supplement it is just as effective. The amounts vary according to the fish oil you purchase but you can add about a teaspoon for each 25 pounds. This is so effective for most dogs that you may find he needs no Apoquel, Cytopoint, or other medications; build up to this amount though since if you give the whole dose immediately your dog can have diarrhea.
Shampooing
Some dogs that suffer from grass or other contact allergies will do well with a simple shampoo if their exposure to the allergen is limited. This is not always effective it is an inhalant allergy so you will have to see how he responds. The most effective shampoo now available is Douxo, which also sells with a mousse that contains ophytrium and is very effective against mild itching; if this is too expensive some dogs respond to a simple cooling bath with colloidal oatmeal.
Antihistamines
The next step would be to treat him with antihistamines if he has a severe bout of itching. This is not a great option as only some dogs (less than a third) respond to antihistamines and there is no way to determine which one of them, if any, is going to help.
Steroids
There are so many side effects to this type of treatment that I would not recommend it for your dog. If he was itching severely and had a severe reaction to the Apoquel and did not respond to the Cytopoint it would be worth trying this option. But please read about the side effects before starting.
Immunotherapy
If you have tried the alternatives like shampooing and antihistamines and he is still miserable the best suggestion would be to consult with a veterinary dermatologist so you can start on allergen-specific immunotherapy. This is a potential cure, the only one available, and in 59.9% of allergic dogs, the signs of itching and scratching were reduced to less than half. (4)
Summary and Recommendation
When comparing Apoquel vs. Cytopoint, the key differences are how they work, side effects, and cost. Apoquel suppresses the immune system, which can lead to infections and may worsen existing cancers. Cytopoint blocks itch-causing proteins with fewer immune risks (but requires vet visits for the injections). Although Cytopoint may cost less per dose, it can end up as expensive as Apoquel due to additional vet fees.
The only potential cure for your dog is an allergy test (to determine exactly what he is allergic to) and allergy injections. Apoquel and Cytopoint will be quicker and may provide immediate relief but be sure to compare Apoquel vs. Cytopoint and go into this aware of the potential problems.
References
- Cosgrove SB, Cleaver DM, King VL, Gilmer AR, Daniels AE, Wren JA, Stegemann MR. Long-term compassionate use of oclacitinib in dogs with atopic and allergic skin disease: safety, efficacy and quality of life. Vet Dermatol. 2015 Jun;26(3):171-9, e35. doi: 10.1111/vde.12194. Epub 2015 Feb 16. PMID: 25688708. https://pubmed.ncbi.nlm.nih.gov/25688708/
- Gober M, Hillier A, Vasquez-Hidalgo MA, Amodie D, Mellencamp MA. Use of Cytopoint in the Allergic Dog. Front Vet Sci. 2022 Jul 19;9:909776. doi: 10.3389/fvets.2022.909776. PMID: 35928119; PMCID: PMC9343842. https://pubmed.ncbi.nlm.nih.gov/35928119/
- Outerbridge CA, Jordan TJM. Current Knowledge on Canine Atopic Dermatitis: Pathogenesis and Treatment. Adv Small Anim Care. 2021 Nov;2:101-115. doi: 10.1016/j.yasa.2021.07.004. Epub 2021 Sep 29. PMID: 35721364; PMCID: PMC9204668. https://pubmed.ncbi.nlm.nih.gov/35721364/
- Fennis EEM, van Damme CMM, Schlotter YM, Sinke JD, Leistra MHG, Bartels RT, Broere F. Efficacy of subcutaneous allergen immunotherapy in atopic dogs: A retrospective study of 664 cases. Vet Dermatol. 2022 Aug;33(4):321-e75. doi: 10.1111/vde.13075. Epub 2022 May 30. PMID: 35635279; PMCID: PMC9544551. https://pmc.ncbi.nlm.nih.gov/articles/PMC9544551/
