Efficacy of proactive long‐term maintenance therapy of canine atopic dermatitis with 0.0584% hydrocortisone aceponate spray: a double‐blind placebo controlled pilot study

Abstract

Background -Long-term remission between flares of canine atopic dermatitis (CAD) can be difficult to achieve. Therefore, additional strategic forms of treatment are needed in order to target flare prevention. The concept of proactive therapy is recommended in the European guidelines for the treatment of human atopic eczema.Objectives -To evaluate the efficacy of a proactive treatment regimen with a 0.0584% hydrocortisone aceponate (HCA) spray for CAD. Animals -Client-owned dogs with spontaneous atopic dermatitis (AD) (n = 41).Methods -This pilot study was conducted as a randomised, placebo-controlled, double-blinded clinical trial with an end-point of treatment failure. Dogs were treated once daily to remission, then randomly assigned to receive either the HCA spray (n = 21) or a placebo (n = 20) spray on two consecutive days each week. All dogs were on appropriate flea control. No topical or systemic anti-inflammatory or antimicrobial agents were permitted. Intention-to-treat analysis was used.Results -At Day 0, all the dogs were in remission or had mild AD based on their Canine Atopic Dermatitis Extent and Severity Index, version 3 (CADESI-03) scores. The time to relapse was significantly higher in the HCA group (median 115 d; range 31-260 d) compared to the placebo group (median 33 d; range 15-61 d) (P < 0.0001). No adverse events were attributable to the HCA spray. Four dogs were lost to follow-up and four were withdrawn after receiving prohibited medication.Conclusions and clinical importance -These results indicate that proactive long-term therapy of CAD with an HCA spray administered on two consecutive days each week is effective and well-tolerated.

Proactive maintenance therapy of canine atopic dermatitis with the anti‐IL‐31 lokivetmab. Can a monoclonal antibody blocking a single cytokine prevent allergy flares?

“…Although these results cannot be compared directly because of differences in canine populations and study designs, the TTF that we observed after lokivetmab proactive therapy seems to be about twice that seen without any treatment, but only half that obtained with twice‐weekly proactive topical glucocorticoid therapy . Furthermore, we compared our post‐lokivetmab Kaplan–Meier TTF curve with those of the HCA proactive study using a partial dataset provided by the authors of that study; the TTFs after lokivetmab therapy were significantly longer than those after placebo but not after the HCA (data not shown). We suspect that, compared to the topical HCA, the lower median TTF seen after lokivetmab is likely due to both a broader anti‐allergic effect of the glucocorticoid and a limited role of IL‐31 in the inflammation of atopic skin.…”

“…The median TTFs after placebo and HCA proactive therapy were 33 and 112 days, respectively . Although these results cannot be compared directly because of differences in canine populations and study designs, the TTF that we observed after lokivetmab proactive therapy seems to be about twice that seen without any treatment, but only half that obtained with twice‐weekly proactive topical glucocorticoid therapy . Furthermore, we compared our post‐lokivetmab Kaplan–Meier TTF curve with those of the HCA proactive study using a partial dataset provided by the authors of that study; the TTFs after lokivetmab therapy were significantly longer than those after placebo but not after the HCA (data not shown).…”

“…The median TTFs after ciclosporin and methylprednisolone discontinuation, estimated from the published Kaplan–Meier figure, were 44 and 26 days, respectively . In the second study, 41 dogs were treated with an HCA spray (Cortavance, Virbac) and then, once signs were in remission or comparable to those of mild AD, they were treated with weekend applications of proactive HCA or placebo. The median TTFs after placebo and HCA proactive therapy were 33 and 112 days, respectively .…”

“…In the second study, 41 dogs were treated with an HCA spray (Cortavance, Virbac) and then, once signs were in remission or comparable to those of mild AD, they were treated with weekend applications of proactive HCA or placebo. The median TTFs after placebo and HCA proactive therapy were 33 and 112 days, respectively . Although these results cannot be compared directly because of differences in canine populations and study designs, the TTF that we observed after lokivetmab proactive therapy seems to be about twice that seen without any treatment, but only half that obtained with twice‐weekly proactive topical glucocorticoid therapy .…”

“…A similar proactive treatment strategy has been proposed for the treatment of canine AD. Proactive long‐term weekend therapy with a hydrocortisone aceponate (HCA) spray (Cortavance, Virbac; Carros, France) extended almost four‐fold the median time‐to‐flare (TTF) in dogs with AD compared to a placebo spray; it was generally well‐tolerated . Because a lasting remission between flares of canine AD is often difficult to achieve, there would be value in exploring additional proactive strategies to prevent disease exacerbations.…”