I just read the patient brochure and did a little digging online.
I'm not feeling so comfortable with it right now and may pass on it. I don't like the part about "APOQUEL may
cause pre-existing cancers to get worse."http://skinvet.wordpress.com/2014/02/01 ... ne-part-2/
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"Finally, what about the issue of neoplasia and cancer? It is thought that immunomodulating drugs can, in general, predispose patients (humans and dogs) to some forms of cancer, thus the FDA has certain labeling requirements concerning immunomodulating drugs. The Apoquel package insert carries a warning that Apoquel “may exacerbate neoplastic conditions.” There is no way to disprove this statement, so although no neoplasms were observed in the laboratory safety studies, and the causality of some of the tumors that developed in the field trials were ruled out based on a very short period of time between starting the drug and tumor diagnosis, the statement sticks. Here is the information available regarding the open-label, long-term continuation study (239 dogs) in the Freedom of Information Summary:
“Six dogs were euthanized because of suspected malignant neoplasms: including one dog each with thoracic metastatic, abdominal metastatic, splenic, frontal sinus, and intracranial neoplasms, and transitional cell carcinoma after 17, 120, 175, 49, 141, and 286 days of oclacitinib maleate administration, respectively. Two dogs each developed a Grade II mast cell tumor after 52 and 91 days of oclacitinib maleate administration, respectively. One dog developed low grade B-cell lymphoma after 392 days of oclacitinib maleate administration. Two dogs each developed an apocrine gland adenocarcinoma (one dermal, one anal sac) after approximately 210 and 320 days of oclacitinib maleate administration, respectively. One dog developed a low grade oral spindle cell sarcoma after 320 days of oclacitinib maleate administration.”
Ideally we would evaluate the prevalence of each diagnosis against a database of dogs with a comparator group with similar demographics. But of course that isn’t readily available. So we are left to consider whether the prevalence of neoplasia in these 239 dogs (5%) is unusually high. My local veterinary oncologist and I don’t find the prevalence unusual, although we don’t have all the demographic data that would help us evaluate it."
I know the evidence is sketchy but cancer is a hot button issue for me; as my 2 major losses (one person, one dog) were both due to cancer and just the mention of the "C word" freaks me out.
Anyone have any thoughts on this? I really think I'm going to hold off if I can get by with mostly zyrtec and the occasional temeril p for flare ups. I know neither of those are great options...but I'm not aware of a cancer connection...
I would feel better if Apoquel had been on the market A LOT longer with more longitudinal studies....