Just Ask the Expert: Tips for using cyclosporine long-term in atopic dogs

Dr. Bloom welcome dermatology questions from veterinarians and veterinary technicians.

Click here to submit your question, or send an e-mail to vm@advanstar.com with the subject line "Dermatology questions."

Q. What is your dosing protocol for long-term cyclosporine therapy in dogs? Do you treat dogs seasonally?

A. First, let's look at appropriate situations in which to use modified cyclosporine in atopic dogs. Keep in mind that in all of these situations, the patient should have moderately severe or severe pruritus, have been found to have atopic dermatitis due to environmental allergies, and have had cutaneous adverse food reactions, flea allergy dermatitis, pyoderma, and Malassezia dermatitis ruled out as a cause of the allergies. As long as dogs meet these criteria, I use modified cyclosporine:

• To be able to withdraw corticosteroids from dogs that have been receiving them for more than two continuous months—I use it to try to prevent exacerbation of pruritus.

• To control pruritus in patients in which I want to perform intradermal testing, since patients cannot have received prednisone orally or topically for 30 days before testing, a triamcinolone injection for 30 days before, or a methylprednisolone injection for 90 days before

• To control pruritus in patients as I await response to allergen-specific immunotherapy (six to 12 months)

• In dogs that have unacceptable side effects to corticosteroids

• In cases in which owners have what I call steroidphobia—in other words, they don't ever want to their dogs to receive corticosteroids but the pruritus is intense

• In dogs that have diseases that are complicated by corticosteroids, such as diabetes mellitus or recurrent pyoderma.

GETTY IMAGES / LUIS ALVAREZ

Long-term dosing

As for how I use cyclosporine long term, I use 5 mg/kg orally once a day for 30 days. If after 30 days the pruritus is controlled without corticosteroids, then I decrease the frequency to every 48 hours for 30 days. If the pruritus remains controlled, I decrease the frequency again to two times a week for 30 days, and then I stop administration if the pruritus is still controlled.

If at any point during the tapering the clinical signs of pruritus become unacceptable, I first recheck the dog to rule out pyoderma, Malassezia dermatitis, and flea allergy dermatitis. If none of these conditions are present, I go back to the last effective dose and frequency for one to three weeks. Once the pruritus becomes acceptable, I then lower the dose but do not change the frequency.

For example, if 100 mg once a day for 30 days works and then 100 mg every 48 hours for 30 days works, yet 100 mg twice a week does not work, I go back to 100 mg at a frequency of every 48 hours to get the pruritus back under control. Then I try 50 mg every 48 hours for 30 days, then 25 mg every 48 hours for 30 days, etc.

Seasonal use

I do use cyclosporine seasonally in a patient that meets any of the criteria listed above. Start 30 days before allergy season and continue the daily dose until 30 days into allergy season. If the pruritus is controlled, you can start the tapering as suggested above.

Monitoring and more

Keep in mind that treating atopic dermatitis involves multimodal therapy and frequent rechecks. Perform a complete blood count, serum chemistry profile, urinalysis, and urine culture every six months in any patient receiving modified cyclosporine for six months or longer. In addition to administering modified cyclosporine, you should:

1. Prevent fleas and manage pyoderma or Malassezia dermatitis if they arise.

2. Promote good skin care by bathing the dog at least weekly and adding an after bath moisturizer.

3. Add fatty acids to the diet.

4. Moisturize the skin as needed during the week.

5. Protect the skin if needed with shirts, socks, or both.

Paul Bloom, DVM, DACVD, DABVP

Allergy, Skin and Ear Clinic for Pets

Livonia, Mich.

Paul Bloom, DVM, DACVD, DABVP