# Cytopoint injection



## Fiona M (Jun 15, 2018)

Hi, I am new here. My 2 yo show type English Cocker Spaniel has developed some sort of allergy. The vet we saw initially suggested allergy testing was not necessary, as at the end of the day we were just going to treat him with something. After a month on Apoquel we returned to the vet today for review, but our usual vet was off, and we saw someone different. 
I'd noticed he was lethargic on the Apoquel, he was not going for his walks with the usual enthusiasm, and after taking it in the mornings he would hop back into his basket and doze for a couple of hours Was absolutely horrified to find, according to their scales, he has put on 2kgs in weight in 4 weeks! (so now is technically 'overweight' to add insult to injury!).
Vet decided that although things have improved a lot, the Apoquel has not totally fixed his problems; his skin is still quite pink, and I notice he gets a bit 'ticklish' after about 12 hours when the Apoquel starts to wear off.
So ... Vet talked me into switching to monthly Cytopoint 20mg injections, and he had his first one today. 
Now, I know Apoquel isn't cheap, but cost of Cytopoint wasn't mentioned today. It's going on the same insurance claim at the mo, but I wonderd if anyone has any experience of this drug and it's efficacy (I gather it's only recently licensed?) and also how much people are paying for it?
Many thanks for any info.


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## lullabydream (Jun 25, 2013)

From the handful of people I know they really rate cytopoint.

https://www.petforums.co.uk/threads/hello-any-oldie-members-still-around.487639/page-3

This is where a old member @GoldenShadow has just posted a brief update on her dog Rupert who really has struggled with Atopic...basically in laymen's terms reacts to most things in the environment and food. If she sees this and is popping in she may give more information.

I think people here have complained about the cost but if you are keeping your pet symptom free with no side effects it's probably not as expensive as it seems. iE you might be paying for additional meds to help with side effects or medication to assist in lessen symptoms whereas no need for with cytopoint.


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## Fiona M (Jun 15, 2018)

Thank you, I'll have a look at the thread you quoted. Don't get me wrong, I would not hesitate to spend whatever it takes to put things right for my boy. I just would like to know how much this stuff costs as it wasn't mentioned today and at the meoment it's going on the existing insurance claim so I suppose the vet saw no reason to alarm me by mentioning the price!


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## Fiona M (Jun 15, 2018)

Thought it might be useful to update. 
My boy had around 3 weeks of relief from the first dose of Cytopoint. 4 weeks later we went back for review, and he had a second dose. Sadly, no relief at all from the second dose. One hotspot opened up after another, his ears flared up again, and he also had a reaction to his annual vaccs, which has never happened before. Long story short, he has now been referred to a Dermatolgy specialist.


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## lullabydream (Jun 25, 2013)

Such a shame. I am so sorry to hear this.

Fingers crossed the specialist can help.

If only dogs read textbooks so they knew what should work for them and followed through. Unfortunately biology isn't quite like that.


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## GoldenShadow (Jun 15, 2009)

Didn’t see this until now, so sorry you’ve had no luck with this.

The going rate where I am is £130 a go, Rupert is 27kgs but I don’t know which size of vial is used on him to be honest.

Rupert reacted less well to his third one, but then responded better to his fourth and I think he is due his fifth or sixth now. I was worried they’d given him the wrong product given the complete lack of relief after the third. Is it possible the heat is causing extra itching at present?

We have been to the moon and back thing to figure out what causes Rupert’s problems. He had intradermal skin tests which were all clear, blood tests all clear, the only thing that ever flagged were a few intolerances on a saliva test (had to send a sample to the USA). I tend to rotate protein sources every few months else he has stomach problems. In the last year since we moved his itching hasn’t calmed at all which is why we were on apoquel and now cytopoint.

I also don’t get Rupert done on a four weekly or monthly basis, when he starts to get a bit uncomfy I take him in, he’s lasted about 5.5 weeks this time around.

My mind is a bit hazy but I seem to remember that cytopoint tends to work in dogs because it is only one enzyme that causes itchiness whereas in cats and humans multiple enzymes cause issues. It seems a bit peculiar that he got on well with it the first time and not the second as a result (my vet said it will either work or it won’t, it won’t work a bit etc), can you think of anything else that was different environmentally when he had his first shot?


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## Fiona M (Jun 15, 2018)

@GoldenShadow Thank you for the further info. My boy weighs 17kg now, and was given 20mgs Cytopoint, which I think was £92.
I certainly don't think the hot weather has helped. He's quite heavy coated and always struggles with regulating his temperature in warmer months.
Apoquel worked a treat whilst he was on the BD dose, but as soon as he dropped to daily it lost clout. After 10 - 11 hours, he would start to scrat again. It also seemed to make him less active, less inclined to play, reluctant to go for walks, and he packed on quite a significant amount of weight. This was the main reasoning behind the switch to Cytopoint.
The first dose of Cytopoint seemed to work well, but towards the end of the third week I could tell it was wearing off. The second dose was given on day 28, and he also had his annual booster vaccinations on the same day - opposite side. He had a big swelling on the vaccination site two days later, the size and shape of a large pork sausage. Also was off colour; lethargic, quiet (I would say depressed, actually), and there was no relief from the itching and scratching. In my opinion, he got gradually worse after the second injection. His ears flared up again, despite rigorous daily cleaning. After 10 days he had three hot spots in various places, so I rang the vets to have him seen again urgently.
We saw the dermatologist two days ago. He had intradermal testing which showed strong positives for several tree and grass pollens, plus house dust and Malassezia. He also has lip fold dermatitis and bilateral ear infections. He's been put on oral steroids, Malaseb baths on alternate days, daily Malaseb beard shampoo, and topical treatments for the ears and lip folds.
It's early days, of course, but he seems to already have considerable relief already from the oral steroids, and the bathing etc. It seems it's going to be an annual thing, the pollen culprits (Oak, Plantain, Velvet Grass and Nettle) seem to be around from March to September. My understanding is that the Malassezia is an opportunist yeast infection which he is also unfortunately allergic to. House dust is obviously down to me, and I have a very comprehensive handout from the dermatologist with hints as to how to better manage this. I'll update further in due course.


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## lullabydream (Jun 25, 2013)

There should be more help on asthma sites..it used to be Asthma UK but could be something else, to help with dust mites.
If it helps using RIP fleas helped my asthma mostly triggered by hayfever but I think dust mites too.

Have a look round at the site to be honest I haven't been there for years but had great information about triggers and dealing with them, dust mites was one as it's common . It might include moulds and fungi too. Could follow guidance if appropriate.


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## Fiona M (Jun 15, 2018)

Thanks for that @lullabydream, I will check it out. Interestingly, he's allergic to actual house dust, rather than the dust mites. The dermatologist was very keen to point that out! She gave me a good advice sheet (7 pages), which I also need to study in more detail.


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## lullabydream (Jun 25, 2013)

Well it will basically be the same thing such as wet wiping so you don't throw dust around...HEPA filters in Hoover's, keeping filters clean. Wash soft toys regularly.

When you wet wipe I put essential oils in the water so it smells nice!

Good luck. Hope it helps


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## GoldenShadow (Jun 15, 2009)

I’m really pleased you got some results on the intradermal skin tests, at least that helps you on the way to a cause. Can they make him up some vaccinations for his allergies? I think not all dogs have success with those but they can be made for whatever the allergens that show.

Rupert was similar actually on the Apoquel, struggled on the maintenance dose which was worrying. His ears often are the first sign of a flare up. I’d be wary of getting your lad vaccinated at the same time as anything else in future, it sounds like his body finds it all quite overwhelming, poor lad. Rupert has gotten progressively worse with his reactions to vaccinations and I no longer get him done now.

How’s he doing today? Hopefully cooling down after tomorrow..!


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## Fiona M (Jun 15, 2018)

He’s continuing to improve, thanks. The bathing routine is time consuming, but I don’t mind (good job I’m retired!) and at least I can see a big improvement, and he’s generally happier in himself. He’s on alternate days with the prednicare now. Only problem really is that it’s making him feel really hungry, and he can’t afford any more weight gain, especially as he is not keen on exercising much lately. His activity level has plummeted in this hot weather, plus I suppose he’s been feeling lousy, so he’s been waddling about like an old man!. Fingers crossed he will perk up when the weather breaks. He’s going to the groomer on Wednesday, so I’ll get him clipped short to get a better skin contact with the malaseb.
The dermatologist didn’t mention any vaccinations, she said there’s no cure and it’ll be a case of seasonal management. She also warned me that it was likely to get worse as he gets older. I suppose I’ll learn more when we go back for review on 23rd. I will ask her about vaccination then, thanks.
Re the cytopoint and the booster, I did ask whether they were able to be given together, the vet said no problem as long as they’re given at different sites, but i wouldn’t do it that way again. I mentioned it to the dermatologist but she didn’t think there was any link.


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## Fiona M (Jun 15, 2018)

Hi, haven't posted in a while. Time for an update.
We've had a long summer on steroids, and lots of ear and lip fold treatments, antibiotics etc. These all seemed to do the trick and I was feeling quite hopeful. Once we got on top of the infections, the dermatologist suggested trying Apoquel again. Just as last time, Blue quickly became lethargic and gained weight rapidly - 700grams in two weeks!
I requested a change of tack, I did not want him eating and sleeping round the clock, which was all he wanted to do on Apoquel. So he's back off it, and we are now trying a systemic anti fungal (Itrafungol) plus immunotherapy injections, and topical treatments for any flare-ups - ie between the toes, in the lip folds, under his collar etc. The twice weekly bathing with Malaseb is also to continue.


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