Long Term Use of Lokivetmab Monotherapy and its Expression in a Beagle with Severe Atopic Dermatitis: First Clinical Study from India

Lokivetmab (Cytopoint®, Zoetis) has been shown to be effective for the short-term treatment of dogs with allergic and atopic dermatitis but there are no studies at US label dosing (at least 2 mg/kg every 4–8 weeks as necessary) which evaluate long-term usage. The objective of this study was to follow a cohort of dogs receiving lokivetmab to treat their canine atopic dermatitis (CAD) over 12 months. The initial phase of this interventional cohort study evaluated a dog’s pruritus following monthly injections (up to 3 injections) of lokivetmab. Dogs who achieved pruritus < 36 mm using a Pet Owner Pruritus Visual Analogue Scale (PVAS) scoring system during the initial phase, were included in this study. Dogs received lokivetmab injections per the US label every 4–8 weeks and returned on days 180 and 365 (± 7 days) after their initial Day 0 for examination by investigators. Pet owners were asked to complete an electronic PVAS assessment every 2 weeks. At each visit, investigators completed a Canine Atopic Dermatitis Extent and Severity Index (CADESI-4) score and VetVAS to measure skin lesion scores. There were 87% (64/75) of dogs who maintained a PVAS below their baseline PVAS on Day 0. Over the course of the study, 88% (65/75) of dogs obtained a mean PVAS below 36 mm. Of those dogs, 31% (23/75) achieved a biweekly PVAS that was below 36 for the entirety of the study with 11% (8/75) having a biweekly PVAS score that stayed below 20 (considered normal dog level of pruritus) for the entire study. Most owners (93%; 64/49) were satisfied with lokivetmab with 88% planning to continue lokivetmab usage. The majority (80%; 55/69) of pet owners reported they were able to reduce the use of other products while their dog was using lokivetmab, and 87% (60/69) of owners found caring for their dog’s atopic dermatitis was easier with lokivetmab compared to prior treatments.

Studies on serum interleukin (IL)-31 levels in dogs with atopic dermatitis (AD) and their correlation with disease severity are limited. To the author's knowledge, there are no studies that measured serum IL-31 in dogs treated with lokivetmab injections, a selective inhibitor of this key cytokine in pruritus. The aim of the study was to evaluate serum IL-31 levels in dogs treated with lokivetmab and correlate it with the severity of canine atopic dermatitis using the pruritus visual analog scale (pVAS) and canine atopic dermatitis extent and severity index (CADESI-04). Ten client-owned dogs diagnosed with AD received two injections of lokivetmab four weeks apart. Disease severity was assessed using the pVAS and CADESI-04 scores before and after both injections. In addition, canine serum IL-31 levels were measured at the same moments. Serum IL-31 was detected in all dogs in the study. There was a significant reduction in pVAS scores and serum IL-31 after administrations. However, there was no difference in CADESI-04 scores, and there was no significant correlation between CADESI-04 scores and serum IL-31 in dogs diagnosed with AD. Nonetheless, a significant positive correlation was observed between the pVAS scores and serum IL-31 levels with lokivetmab therapy, which reinforces the role of IL-31 in the pathogenesis of pruritus in dogs with AD. The data presented here provide further evidence that IL-31 is directly involved in pruritus pathogenesis in dogs with AD. In addition, blocking IL-31 has a significant antipruritic effect, but has no influence on skin lesion severity and extension.

Fine bubble (FB) bathing has shown benefits on a mouse model of atopic dermatitis (AD). However, its efficacy in dogs with AD remains to be evaluated. This study aimed to assess the clinical effectiveness of FB bathing in dogs with AD. Seventeen dogs with AD whose clinical presentation showed a Canine Atopic Dermatitis Extent and Severity Index, 4th iteration (CADESI-04) score of <40. The dogs were randomly assigned to either the FB bathing group or the shampoo group. The treatments were administered once a week as per the instructions, in a trial totalling 4 weeks. Evaluations were conducted on Day (D)0 and D28 to assess the outcomes of the trial. The severity of AD was measured using the CADESI-04 and the pruritus Visual Analog Scale (PVAS). The skin barrier function parameters, transepidermal water loss (TEWL) and stratum corneum hydration were measured before and after the treatment. Both treatment groups demonstrated a decreasing trend in CADESI-04 scores, yet the FB group exhibited significant improvement in comparison to the shampoo group after 1 month of trial. There were no significant changes in PVAS scores in either group. No significant difference was found in skin barrier function parameters between the two treatments, although TEWL slightly decreased in the FB group and slightly increased in the shampoo group after treatment. These results suggested that FB treatment provides benefits for dogs with AD and offers an alternative topical treatment option with a lesser impact on skin barrier function compared to frequent shampooing.

Canine atopic dermatitis is a common chronic inflammatory skin disease characterized by pruritus and recurrent erythema, yet objective blood biomarkers for monitoring disease activity remain limited. In this study, we evaluated serum cytokine profiles and their associations with clinical severity in client-owned dogs with atopic dermatitis. A total of 143 dogs were enrolled, including 28 healthy and 115 dogs with atopic dermatitis. The atopic dermatitis group was further categorized into untreated dogs (n = 27; no systemic therapy for ≥4 weeks) and systemically treated dogs (n = 88). Serum concentrations of IFN-γ, IL-10, IL-13, IL-31, and TGF-β1 were measured using an enzyme-linked immunosorbent assay. Group differences were assessed using the Kruskal-Wallis test with Bonferroni-adjusted post hoc comparisons, and correlations with the pruritus visual analog scale (pVAS) and the Canine Atopic Dermatitis Extent and Severity Index-04 (CADESI-04) were analyzed using Spearman's rank correlation. Serum IFN-γ, IL-13, and IL-31 concentrations differed significantly among groups (p < 0.001, p = 0.001, and p = 0.004, respectively). IFN-γ and IL-13 concentrations were lower in treated dogs than in healthy dogs and untreated dogs, whereas IL-31 concentrations were higher in dogs with atopic dermatitis than in healthy dogs, regardless of treatment status. In correlation analyses, the pVAS showed a negative correlation with IFN-γ (r = -0.239, p = 0.004) and a positive correlation with IL-31 (r = 0.173, p = 0.039), while CADESI-04 showed a negative correlation with IFN-γ (r = -0.252, p = 0.002). IL-10 and TGF-β1 did not show significant differences among groups or correlations with clinical indices. These findings suggest that serum IL-31 may reflect pruritus-related immune signaling that can persist despite clinical improvement. While IFN-γ may show a weak negative correlation with clinical severity indices, its potential association with chronic dermatologic changes, such as lichenification, requires further investigation in relation to disease chronicity. Together, these results indicate that circulating cytokine profiles and clinical indices do not necessarily change in parallel and that selected cytokines may provide complementary information when interpreting disease activity in canine atopic dermatitis. These profiles should be interpreted while considering the diverse immunomodulatory mechanisms of the systemic therapy administered.

CBP-201 is a next-generation monoclonal antibody targeting the IL-4Rα subunit. Rapid efficacy with CBP-201 was demonstrated in global phase 2 (WW001) and China-only pivotal trials (CN002) in patients with moderate-to-severe atopic dermatitis (AD). Previous studies of AD therapy demonstrated similar efficacy between moderate and severe disease, with a trend toward greater improvement in moderate patients. It is unknown whether there are differences in clinical response to CBP-201 with moderate vs.severe AD. We report post hoc efficacy analyses at Week 16 with CBP-201 300 mg from WW001 in baseline severity subgroups, based on validated Investigator Global Assessment (vIGA™) scores of 3 (moderate) and 4 (severe). In WW001 (NCT04444752), adults with moderate-to-severe AD were enrolled in a RDBPC 16-week trial of subcutaneous CBP-201 or placebo. For post hoc analysis, data for 300 mg every 2- and 4-week dose regimens were pooled. Investigators assessed AD severity using Eczema Area and Severity Index (EASI), SCORing AD (SCORAD), percent Body Surface Area (BSA) of AD involvement and vIGA. Patient-reported outcomes were assessed with the Dermatology Life Quality Index (DLQI) and Patient Oriented Eczema Measure (POEM). Least squares mean (LSM) score changes were analysed using ANCOVA modeling (including treatment, baseline score and baseline vIGA), with missing data interpolated by last observation carried forward. Responder endpoints were analysed using Clopper–Pearson methodology and, for missing values, nonresponder imputation. P-values are for CBP-201 vs. placebo, per baseline severity subgroup, at Week 16. At baseline, 113 patients had moderate AD (n = 74 CBP-201, n = 39 placebo) and 56 patients had severe AD (n = 39 CBP-201, n = 17 placebo). Baseline EASI scores were lower in the moderate subgroup [mean (SD): CBP-201, 21.5 (7.0); placebo, 22.2 (6.3)] vs. the severe subgroup [CBP-201, 33.6 (11.9); placebo, 31.9 (10.8)]. In both the moderate and severe AD subgroups, significant improvements with CBP-201 vs. placebo were observed. Except for the proportion of patients achieving vIGA 0/1, numerically greater CBP-201 responses were observed in patients with severe vs. moderate AD at Week 16; placebo responses were comparable per subgroup. In the severe and moderate subgroups, LSM SCORAD scores decreased by −42.8% (severe) and −29.8% (moderate), and LSM percent BSA decreased by −29.8% and −17.3%, respectively. Clinically meaningful 2-point improvement in vIGA was reported for 48.7% and 27.0% of patients with severe and moderate AD, respectively. The proportions of patients achieving vIGA 0/1, with 2-point improvement, were 20.5% and 27.0% with severe and moderate AD, respectively. Numerically greater proportions of patients with severe vs. moderate AD experienced EASI responses with CBP-201: EASI-50, 66.7% vs. 54.1%; EASI-75, 53.8% vs. 39.2%; EASI-90, 28.2% vs. 23.0%. Patients with severe vs. moderate AD reported greater improvements in patient reported outcomes with CBP-201: DLQI, −8.7 vs. −7.0; POEM, −12.5 vs. −8.7. Clinically meaningful improvements were observed in patients with AD with either moderate or severe AD after 16 weeks of treatment with CBP-201 300 mg at either 2- or 4-week dosing. There were no differences noted between moderate and severe patients in the placebo treatment group. In most severity readouts, greater proportions of patients with AD with severe disease on study entry experienced clinically meaningful improvements with CBP-201. In future CBP-201 trials, a more severe AD population needs to be examined to determine if this same observation is also noted. Collectively, the WW001 findings support further investigation of CBP-201, at both the 2- and 4-week dosing schedules enrolling larger numbers of moderate and severe patients with AD and with prespecified analyses by baseline AD severity.

Risk of myocardial infarction, ischemic stroke, and cardiovascular death in patients with atopic dermatitis

Canine atopic dermatitis (cAD) is a common allergic skin condition among dogs that may respond to treatment with mesenchymal stromal cells (MSCs). The aim of this pilot study was to evaluate the safety and efficacy of allogeneic uterine tissue-derived MSCs (UMSCs) for the reduction and control of clinical signs associated with cAD. At two sites, seven client-owned dogs with cAD received two doses of approximately 3.6 x 107 UMSCs given intravenously over 30 min, on Day 0 and Day 14, with monthly clinical follow-up until Day 90 and optional owner phone interview on Day 180. Primary outcomes were pruritus and skin lesions. Pruritus was measured by the owner-assessed Pruritus Visual Analog Scale (PVAS), with treatment success defined as a 2-point reduction in PVAS score at any timepoint after treatment. Skin lesions were evaluated by two veterinarians according to the Canine Atopic Dermatitis Extent and Severity Index (CADESI-4). The secondary outcome was safety, which was evaluated via physical exam and hematology, including complete blood count (CBC), serum chemistry, and urinalysis (UA). Treatment was generally well tolerated and associated with a significant reduction in PVAS on Day 30 that was maintained through Day 180. On Day 60, five dogs (71%) achieved treatment success (at least 2-point reduction in PVAS), and three dogs (43%) had a PVAS improvement of 4-5 points. Mean CADESI-4 score was significantly improved on Day 14, Day 30, Day 60, and Day 90, with the lowest mean score observed on Day 60. Three dogs exhibited mild and transient adverse events. These findings suggest that IV-administered allogeneic UMSCs reduce and control clinical signs of cAD, with a durable benefit lasting 3–6 months.

Allergen-specific immunotherapy (ASIT) is the only causative treatment of canine atopic dermatitis (cAD). Different routes for administration of ASIT have been used; however, comparative studies are lacking. The present study compared the efficacy and safety of subcutaneous (SCIT), intralymphatic (ILIT) and sublingual (SLIT) immunotherapy. 30 atopic dogs were included and allocation to three groups (SCIT, n=8; ILIT, n=12; SLIT, n=10) was determined by the owners. ASIT was administered using routine protocols. The pruritus Visual Analog Scale (PVAS), canine atopic dermatitis extent and severity index (CADESI), concurrent medications and adverse events were recorded initially and one, three, six and 12 months later. The main outcome measure was return to a normal status, which included CADESI <12, PVAS <2.5 and medication score <10. Drop-outs were distributed evenly and 23 dogs finished the study (SCIT, n=6; ILIT, n=10; SLIT, n=7). Adverse reactions to treatment were rare. At the start of the study, the three groups were homogeneous with respect to clinical signs and concurrent medications. After 12 months of ASIT, the CADESI and PVAS had decreased with a stable medication score in the ILIT and SCIT groups (P < 0.05), while all three scores had increased in the SLIT group. Return to normal state was achieved in one of six (17%) dogs receiving SCIT, in six of 10 (60%) dogs receiving ILIT and in one of seven (14%) dogs receiving SLIT. These findings suggest that SCIT and ILIT improved clinical signs of cAD, whereas ILIT had a much higher return to normal rate.

The gut microbiota has been suggested to be involved in the pathogenesis of canine atopic dermatitis (cAD). However, the gut microbiota has not been well characterized in dogs with atopic dermatitis (AD). In addition, the efficacy of fecal microbiota transplantation (FMT) in dogs with AD remains unclear. This research, therefore, aimed to characterize the gut microbiota of dogs with AD and conduct pilot evaluation of the efficacy of a single oral FMT on clinical signs and the gut microbiota of dogs with AD. For these purposes, we used 12 dogs with AD and 20 healthy dogs. The 16S rRNA analysis of the fecal microbiota revealed significant differences between 12 dogs with AD and 20 healthy dogs. Next, a single oral FMT was performed in 12 dogs with AD as a single-arm, open-label clinical trial for 56 days. A single oral FMT significantly decreased Canine Atopic Dermatitis Extent and Severity Index (CADESI)-04 scores from day 0 (median score, 16.5) to day 56 (8) and Pruritus Visual Analog Scale (PVAS) scores from days 0 (median score, 3) to day 56 (1). Furthermore, a single oral FMT changed the composition of the fecal microbiota of dogs with AD at the phylum and genus levels. The number of common amplicon sequence variants in the fecal microbiota between donor dogs and dogs with AD was positively correlated with CADESI-04 and PVAS reduction ratios 56 days after FMT. Our findings suggest that the gut microbiota plays a pivotal role in the pathogenesis of cAD, and that oral FMT could be a new therapeutic approach targeting the gut microbiota in cAD.

The aim of this trial was to assess the clinical efficacy of neural therapy (NT) when treating canine atopic dermatitis. Eighteen dogs (no control group), with at least a 12-month history of having nonseasonal atopic dermatitis, were included. No medication with either glucocorticoids or cyclosporin was allowed during the trial. One set of NT was given by injecting an intravenous dose of 0.1 mg/kg of a 0.7% procaine solution, followed by 10 to 25 intradermal injections of the same solution in a volume of 0.1-0.3 mL per site. Dogs were given 6-13 sets of NT during the therapy. The dermatological condition of each patient was evaluated before and after the treatment using two scales: the pruritus visual analogue scale (PVAS) and the canine atopic dermatitis extent and severity index (CADESI). The reduction of pruritus was statistically significant using a Wilcoxon matched-pairs signed-ranks test (P < 0.001). No adverse side effects were observed. NT seems to be an effective alternative to control signs related to canine atopic dermatitis.

IntroductionMicronutritional deficits are linked to increased morbidity and mortality. Canine atopic dermatitis (CAD) often presents with iron depletion and subclinical inflammation, despite their typical meat-based diets, suggesting widespread micronutritional malabsorption. This study aimed to determine if a complementary lymph food—enriched with whey protein, vitamins, minerals, and antioxidants, and designed to bypass mucosal malabsorption barriers—could improve CAD clinical signs and blood parameters.AnimalsThirty-eight dogs diagnosed with canine atopic dermatitis were included in the study.MethodsIn a 112-day, double-blinded, randomized study, 38 CAD dogs daily received 10 g of either the active lymph food (n = 19) or a hydrolyzed food placebo (n = 19). Owners weekly recorded pruritus using the Pruritus Visual Analog Scale (PVAS) and logged medication use (Janus kinase inhibitors, corticosteroids, antihistamines, cyclosporine, and Lokivetmab). Veterinarians monthly assessed skin lesions via the Canine Atopic Dermatitis Extent and Severity Index (CADESI-4). Blood samples were collected at baseline and at the study's end. Treatment success was defined as a decrease of ≥2 on the PVAS and a ≥50% reduction in CADESI-4.ResultsThe complementary lymph food was well-accepted by the dogs. The active feed group showed significantly greater reductions in both CADESI-4 scores (−55%) and PVAS scores (−1.8) compared to the placebo group (+26%, p < 0.0003 and −0.05%, p = 0.0074, respectively), indicating an added benefit to standard care treatment. Medication use significantly declined in the active group. Furthermore, red blood cell counts, packed cell volume (PCV), and serum iron increased in the active group but not in the placebo group. A threefold significantly greater proportion of dogs in the active group achieved treatment success compared to the placebo group.ConclusionLymphatic nutrient feeding significantly improved CAD symptoms, suggesting a causative role of nutritional deficiencies in driving skin inflammation. This study strongly suggests a beneficial role for targeted lymphatic nutrient delivery in CAD management.

Canine atopic dermatitis (CAD) is a chronic, pruritic inflammatory disease that affects up to 15% of the global canine population. Its etiopathogenesis is multifactorial, involving genetic, immunological, environmental, and dietary factors. It is characterized by pruritus, erythema, alopecia, and secondary lesions, predominantly affecting the abdomen, extremities, and ears. This retrospective cross-sectional descriptive study analyzed 735 medical records of dogs diagnosed with CAD treated at the Veterinary Specialty Center (CEVET) in Quito, Ecuador, between January 2018 and July 2025. Demographic, clinical, housing, diet, and cohabitation data were collected and statistically analyzed using χ2 for qualitative variables and the Kruskal-Wallis test for quantitative variables, with post hoc analysis as appropriate. Additionally, pruritus severity was assessed using the Pruritus Visual Analog Scale (pVAS). A composite Clinical Severity and Distribution Score (CSDS) was also developed to classify disease severity. A multivariate logistic regression model was performed to identify factors associated with severe CAD. The results showed a predominance of CAD in adult dogs (84.2%) and purebred dogs (74.97%), with a slight majority being males (52.38%). Pruritus was the most frequent initial symptom (80.27%), with most cases presenting moderate-to-severe pruritus (pVAS 7-10). The most affected areas were the abdomen (24.49%) and forelimbs (17.68%). The geographical distribution showed a predominance of urban areas (88.84%) and cold climates (86.39%). Based on the CSDS, 53.2% of cases were classified as severe, 44.4% as moderate, and 2.4% as mild. Multivariate analysis revealed that grass exposure was significantly associated with severe CAD (OR = 1.78; 95% CI: 1.22-2.60; p = 0.003), while urban environment showed a non-significant trend toward increased severity (OR = 1.41; p = 0.071). Significant associations were identified involving sex and body weight, age and affected area, and temporal variations in the severity of pruritus, age group, and distribution of lesions. Among breeds, French Bulldogs, Standard Schnauzers, and Shih Tzus had the highest prevalence of CAD. These findings provide the first systematic epidemiological and clinical characterization of CAD in Ecuador, highlighting the role of environmental factors in disease severity and supporting the use of composite clinical scoring approaches in retrospective studies, thereby contributing to understanding of the disease and serving as a reference for early diagnosis, clinical management, and the development of preventive strategies.

Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report

This study investigated effects of a fluoxetine (selective serotonin reuptake inhibitors; SSRI, 1 mg/kg) on pruritus in canine atopic dermatitis (CAD). After 4-weeks of base-line observation, 8 dogs with CAD entered a 2-months randomized, double-blind, placebo-controlled, crossover trial comparing fluoxetine with placebo. Clinical efficacy was evaluated using a Canine Atopic Dermatitis Extent and Severity Index (CADESI-03) and Pruritus Visual Analog Scale (PVAS). Six dogs completed the study [two out of eight dogs (both of them were Shiba Inu) dropped out from the study due to a depression]. CADESI-03 and PVAS between fluoxetine and placebo showed no significant difference statistically (P > 0.05 and P > 0.05 respectively). Fluoxetine showed no efficacy on pruritus in CAD. Further researches are needed for the treatment on pruritus of CAD.

Canine atopic dermatitis (cAD) is a chronic inflammatory skin condition associated with T helper 2 (Th2)-type immune responses, and recent evidence suggests that periostin, an extracellular matrix protein, may play a role in its pathogenesis. To investigate the significance of serum periostin concentrations in dogs with cAD, this study examined their relationship with disease severity and laboratory parameters, including eosinophil counts and Th2 cytokines such as interleukin (IL)-4 and IL-13. A total of 68 dogs diagnosed with cAD and 21 healthy controls were included, with serum periostin, IL-4, and IL-13 levels measured. Disease severity was assessed using the Canine Atopic Dermatitis Extent and Severity Index (CADESI-04) and the Pruritus Visual Analog Scale (PVAS). The results showed that serum periostin concentrations were significantly higher in dogs with cAD compared to healthy controls and exhibited a positive correlation with CADESI-04 scores, reflecting disease severity. Treatment with prednisolone or oclacitinib led to a significant reduction in serum periostin, IL-4, and IL-13 levels, along with a decrease in eosinophil counts. These findings highlight the potential of serum periostin as a valuable biomarker for assessing cAD severity and monitoring treatment response, emphasizing its clinical relevance as an objective measure.