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Application of ESWT requires proper patient preparation. Sedation is recommended as the device creates noise and can cause some pain. It is recommended to shave the area and wipe with alcohol. Ultrasound gel is used as a medium to provide optimal sound wave transmission. The trode is moved around the treatment area, angling the head as needed to reach the target tissue. Generally, 500 to 1000 pulses are applied to each treatment area. The devices can generate 48- pulses per minute, so most treatments take approximately 2 minutes per site. The patient can be discharged as soon as recovered from sedation. The analgesic effect of this therapy necessitates limiting patient activity for three to 5 days post-treatment. NSAIDs may be used, but this may reduce the desired brief inflammatory healing effect. Patients are reevaluated every 2 weeks and retreated as needed. Most indications get the best results with two to three treatments.
M. Burrows1
1Animal Dermatology Clinic Murdoch University Division of Veterinary and Biomedical Science Murdoch, Western Australia
Oclacitinib maleate (Apoquel®) is a novel targeted therapy that selectively inhibits key pathways involved in itch
and inflammation associated with allergy. Oclacitinib selectively inhibits Janus kinase 1-dependent cytokines with minimal effects against Janus kinase 2-dependent cytokines involved in haematopoiesis. Janus kinase 1 enzyme activities play a central role in cytokine signalling and are involved in the signal transduction of many pro- inflammatory, pro-allergic and pruritogenic cytokines implicated in atopic dermatitis, including interleukin (IL)-2, IL-4, IL-6 and IL-13. Janus kinases are also involved in the signalling of IL-31, a recently identified cytokine that has been shown to play a key role in canine pruritus. Oclacitinib has been shown to inhibit IL31 cytokine function in dogs.
Oclacitinib is indicated for control of acute or chronic pruritus in dogs over 12 months of age. The drug is not approved for dogs less than 12 months of age. Oclacitinib administered at a dose of 0.4 to 0.6 mg/kg orally twice daily for up to 14 days and then once-daily thereafter for dogs is highly effective for the management of pruritus and skin lesions in dogs with allergic dermatitis. Oclacitinib has been shown to reduce pruritus and clinical signs
as effectively as prednisolone (Gadeyne 2014) and ciclosporin (Little 2015). The drug has a very rapid onset
of action with relief sometimes apparent within hours of oral administration. Some dogs experience an increase in pruritus when switched from twice to once daily, related to the short half-life of the drug (4 hours). Overall, it appears that at least 60–70% of allergic dogs receiving the drug have rapid, substantial, and prolonged relief of their clinical signs. Veterinary dermatologists often use this drug as part of a multimodal treatment approach.
Short term adverse effects of oclacitinib appear mild
and include gastrointestinal side effects of vomiting and diarrhoea at an incidence of approximately 2%. The long- term administration of oclacitinib administered once-daily appears to be relatively safe. Results of a long-term compassionate use study support the safety of chronic use of oclacitinib and suggest an improved quality of life for the dog and the owner (Cosgrove 2015). Oclacitinib has been administered for as long as 3 years in some dogs; in longer-term studies, occasional patients have developed benign or malignant neoplasms, but no more often than would be expected for dogs in the studied age range.
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