Cytopoint: High Tech Answer to Your Itchy Dog?

Waiting for the Other Shoe to Drop

The curse of the canine itch. If you’ve ever dealt with it, you know the agony of self-mutilation, non-stop chewing and scratching, lost sleep, and often great expense with minimal results.

That seemed to shift when Apoquel came out. Magically less itchy, often within hours of a pill!

Hallelujah!

The expense was significant, but who cares, when your dog stops scratching and the whole household can finally get some serious sleep?

The other shoe on Apoquel seems to drop at varying intervals after first starting the immune tweaking drug.

After the first dose for some of you, or later on, tumors growing in various places, or other immune related diseases cropping up.

And many experienced a steady decline in efficacy. In other words, it worked less and less well each time it was dosed.

More expense, less results for your itchy dog.

This article and its many comments suggest you should tread carefully if you’re considering using Apoquel by Zoetis.

The New Drug on the Block: Get Mabbed

Likely encouraged by the huge rush of profits for its shareholders, Zoetis, the vet pharma giant, brought out another immune tweaking drug, first called CADI (Canine Atopic Dermatitis Immunotherapeutic), but finally marketed as Cytopoint.

It’s an antibody, produced in the lab by a single cloned cell line, so it’s called a monoclonal antibody.

Drugs like this have names typically ending in “-mAb” to reflect this class of antibody, and this one is called lokivetmab.

(I really don’t think they tried hard enough here. Loki? Wasn’t he the super evil dude from another star system?

And this is his “vet mob?” Scary combo, that.

Pictures of evil vets rushing at your dog with syringes drawn…)

Get Out Your Credit Card

It’s an injectable drug, so it’ll be vet-only, and yep, it’s expensive.

If you have followed along here for any amount of time, you’ll have learned that allergies (itchy skin being the #1 manifestation of them in the dog) are, like all chronic diseases, incurable by conventional medicine.

So, if you sign up for this new wonder drug, plan on using it monthly, for life:

However, this is a condition that is going to require lifelong management; and we are going to have to partner together to work through what the underlying cause is: infectious/parasitic, food, inhalant or contact allergies, etc. 1

Oh, the “underlying cause” is food? Inhaled or contacted things? We’ll come to the real underlying cause in a bit.

A Single Purpose Silver Bullet?

As you may recall, an antibody is something that counters something. That’s the “anti-” piece, right?

Often, our natural antibodies are what fight infectious diseases, large or small, from the common cold or flu viruses to the more scary ones like distemper or parvo, the viruses that can kill puppies.

Cytopoint, though, is an artificially made antibody against a natural immune messenger molecule that you and I and your dogs, cats, and horses all have in us.

That messenger molecule, inherent in mammalian immune systems, is called IL-31.

Interleukin 31 is classed as a cytokine, and when they injected it into dogs, the dogs got itchy.

So, is it a bad, bad cytokine that we can just attack with this new antibody scientists have created in their laboratories, and rest easy that we’re doing the world of itchy dogs a favor?

Or, might there be some unintended consequences of messing with Mom Nature?

Here’s what’s known about this cytokine called IL-31, now under injectable antibody attack in dogs near you:

IL-31 acts on a broad range of immune- and non-immune cells and therefore possesses potential pleiotropic physiological functions, including regulating hematopoiesis and immune response, causing inflammatory bowel disease, airway hypersensitivity and dermatitis.2

Pleiotropic?

That just means this ain’t no one trick pony.

…major sites of action are the skin, lung, intestine and the nervous system. Hence IL-31 main role is to facilitate cell-mediated immunity against pathogens. IL-31 and its receptors are also involved in regulating hematopoietic progenitor cell homeostasis.3

Wait, pathogens? Those are disease-causing organisms, aka viruses and bacteria and yeasts, right?

So, IL-31’s “main role” is helping us fight the bad guys?

Oh oh. Cytokine interferes with fighting the disease causers?

What else is this drug interfering with?

“Hematopoietic” refers to our bone marrow’s chief function of making all those blood cells we depend on daily.

• Red blood cells to carry the oxygen

• Various white blood cells to fight disease (T and B cells, natural killer cells, etc.)

• Platelets, which help us clot after injury

Wait a sec. If Cytopoint takes out the thing that helps blood cells that are important to us, that’s a bad thing, right?

So, Is Cytopoint Safe?

That’s the $40K question, isn’t it?

It’s getting lots of press as a high tech, well designed immune tweaking antibody that’s getting results fairly quickly.

Apoquel wasn’t deemed safe for dogs under 1 year of age. Cytopoint?

Dr. Stokking: Young atopic dogs under a year of age are a patient population where there really aren’t any other choices that are beneficial. APOQUEL is not labeled for dogs less than one year of age but we can use CYTOPOINT in these patients. (WF Note: Why are young dogs affected? Experts aren’t even asking this…)4

The study that brought the drug to market was only carried out for seven months.

On 36 laboratory Beagles. A curious species that seems highly resistant to disease.

Definitely not representative of the average dog in the world, as these dogs never leave the lab.

Laboratory Beagle dogs were randomized to three groups (n = 6M/6F per group) and administered seven monthly subcutaneous (SC) doses of 0.9% saline or lokivetmab (3.3, or 10 mg/kg).… Lokivetmab was well tolerated in laboratory dogs when administered subcutaneously at up to 10 mg/kg for seven monthly doses. Disclosure of Interest: Authors received reimbursements, fees, funding or salary from: Zoetis Inc., Florham Park, NJ, USA 5

Are you feeling safe now?

Their in-house study, on 36 lab Beagles, ran for 7 whole months, and there were no problems.

“Let’s get this on the market, boys! No one will notice how small our study was or how short!

There’s money to be made! People hate those itchy dogs and will pay anything to stop them from scratching!”

Crystal Ball Time

I’m not impressed.

I mean, what’s going to happen when it’s out on the market (it is as I write this) in 1000’s of normal dogs for a year?

Or two or three or, umm, LIFE?

So, time to rub the dust off my crystal ball and take a look…

First, do you recall that Cytopoint attacks a part if the immune system called IL-31, and the “IL-31 main role is to facilitate cell-mediated immunity against pathogens?”

And the part about regulating blood cell production?

And the fact that the thing this drug is attacking, this IL-31 thingie, is “pleiotropic?” (Meaning, it can change and do other things we may not even know about yet).

I think it’s safe to say this one, like most designer drugs, will come back to bite us.

How about:

• More susceptibility to parvo, distemper, or dog flu?

• Failed blood cell production, resulting in anemia or thrombocytopenia (not enough clotting cells, so bleeding problems in your dog)?

• Immune deficiency diseases from impaired white blood cell production?

I don’t know if any of this will come about, but does anyone?

Based on a 7 month “safety” study on 36 lab Beagles, I’ve got no reason to assume everything will be just fine.

The Big Why

Of course, the scientists of Big Pharma company who study this would still like you to believe that allergies are caused by fleas.

Or pollen. Or grass. Or chicken.

Things that have been on the planet for a very long time.

And things that not every dog has a hard time with.

Why does anyone get “immune confused” to the point of over reacting to normal things and getting wildly itchy?

It’s the vaccines. That history goes back to at least 1884.

Tell us Your Story

Have an itchy, allergic dog?

Will you be using this new wonder drug called Cyptopoint?

Or are you already? How’s it gone so far?

We all grow wiser by sharing our experiences, and the comments below are a great place to do just that.

1Clinician’s Forum: Canine Atopic Dermatitis: Building a Lifelong Treatment Plan | Clinician’s Brief, Clinician’s Forum: Canine Atopic Dermatitis: Building a Lifelong Treatment Plan, https://www.cliniciansbrief.com/article/clinicians-forum-canine-atopic-dermatitis-building-lifelong-treatment-plan

2Structures and biological functions of IL-31 and IL-31 receptors, PMC, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2659402/

3Interleukin 31 – Wikipedia, Interleukin 31, https://en.wikipedia.org/wiki/Interleukin_31

4Clinician’s Forum: Canine Atopic Dermatitis: Building a Lifelong Treatment Plan | Clinician’s Brief, Clinician’s Forum: Canine Atopic Dermatitis: Building a Lifelong Treatment Plan, https://www.cliniciansbrief.com/article/clinicians-forum-canine-atopic-dermatitis-building-lifelong-treatment-plan

5Long-term laboratory safety study of lokivetmab…, Safety study: “Long-term??”, https://www.zoetisus.com/conditions/dogs/itchcycle/downloads/resources/publications/krautman-long-term-laboratory-safety.pdf, Authors all work for Zoetis.