Veterinary Medicine - May 2008 - (Page 268) Cyclosporine PEER-REVIEWED 1. Self-trauma resulting from atopic dermatitis in a 3-year-old cat. Note the preauricular erythema. 2. The same cat as above. Note the papular eruption and facial inflammation caused by facial rubbing. be needed to con rm the diagnosis, but it is necessary to formulate an allergenspeci c immunotherapy protocol. When deciding on a treatment plan, considerations include the duration and severity of clinical signs, whether the pet is a working animal (e.g. avoid drugs such as antihistamines that may interfere with a guide dog’s ability to stay alert), and concurrent medical conditions (e.g. diabetes mellitus). Other considerations are described in the boxed text on page 270. Efficacy in studies. Cyclosporine is the newest option available for treating atopic dermatitis, and numerous reports have evaluated its use.11-13 In a systematic review and metaanalysis, 799 dogs in 10 studies had been treated with cyclosporine (n=672), placebo (n=160), oral glucocorticoids (n=74), or antihistamines (n=23).11 Dogs were treated from two weeks to six months, and doses were 2.5 to 5 mg/kg. After four to six weeks of cyclosporine (5 mg/kg once daily), a 40% decrease in skin lesions and at least a 30% decrease in pruritus were noted. The percentage of dogs showing at least a 50% improvement in clinical signs increased from 20% to 60% after four weeks of treatment and from 63% to 87% after 12 to 16 weeks of therapy. At the end of four weeks, in most of the studies, 40% to 50% of dogs had their cyclosporine dosage reduced to should not be given to breeding dogs and pregnant or lactating bitches.9 In addition, because of the drug’s mechanism of action, the manufacturer recommends the use of killed vaccines in patients receiving cyclosporine. In a small study, 16 dogs received either 20 mg/kg daily of cyclosporine or placebo for 56 days and were vaccinated on day 27 with a killed rabies vaccine and a multivalent vaccine that included a modi ed live virus.9 Antibody titers measured on days 0, 27 (before vaccination), 42, and 56 revealed no antibody titer rise in any dog to any of the components of the multivalent vaccine but appropriate antibody titer response in all dogs to the killed rabies vaccine by day 42. Whether this response occurs at therapeutic dosing recommendations (5 mg/kg daily) is unknown. Studies have not been conducted on what length of drug withdrawal is necessary before vaccination. Studies on the safety of cyclosporine have been limited to 12 months. The long-term effects of this potent immunosuppressive drug are unknown. loss is usually permanent), pemphigus foliaceus and erythematosus, sebaceous adenitis, perianal stula, sterile nodular panniculitis, dirty face syndrome (Persian cats), chronic pedal furunculosis, erythema multiforme, follicular hyperkeratosis, German shepherd deep pyoderma, sterile pyogranulomatous syndrome, alopecia areata, and proliferative otitis externa.6 For some of these diseases, strong evidence exists that the drug is ef cacious; however, for most of the other diseases, reports of ef cacy are limited to single cases or anecdotal reports. Of these diseases, cyclosporine (Atopica) is FDA-approved only for use in dogs with atopic dermatitis. This drug is also approved in some countries outside the United States. The primary use of cyclosporine in clinical practice is in treating atopic dermatitis. However, we would also like to brie y describe its use in treating sebaceous adenitis and perianal stulas. Atopic dermatitis Atopic dermatitis is one of the most common pruritic skin diseases in dogs and cats (Figures 1 & 2). While diagnosing atopic dermatitis is beyond the scope of this article, it is imperative that you de nitively diagnose it by ruling out other causes of pruritus (e.g. a parasitic or bacterial infection, a food or ea allergy). before starting treatment. Allergy testing (intradermal or in vitro testing) may not DERMATOLOGIC USES Cyclosporine has been used to treat a wide range of in ammatory and immunemediated skin diseases including canine and feline atopic dermatitis, feline eosinophilic granuloma complex, cutaneous lupus erythematosus, feline pseudopelade (nonin ammatory alopecia in which hair 268 May 2008 VETERINARY MEDICINE
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