Jason B. Pieper, DVM, MS, DACVD talks about the multiple therapies available for cases of moderate and severe atopic dermatitis and delves into each option

Treatment options for moderate and severe atopic dermatitis, and when to use what

, Jason B. Pieper, DVM, MS, DACVD, assistant professor at Iowa State University goes in depth about the various treatment options for moderate and severe atopic dermatitis. Pieper outlines the various agents and therapies that should be used for moderate cases versus severe cases, explaining the advantages and disadvantages of the therapies, and specific cases in which one treatment is preferred over another, or discouraged. In his discussion, he talks about Janus kinase (JAK) inhibitors, cyclosporin, Cytopoint, allergen-specific immunotherapy, monotherapy, steroids, and more.

 to listen to an earlier part of Pieper’s interview, where he talks about treatment options for mild cases of atopic dermatitis.

Below is a partial transcript which has been edited for clarity.

For moderate, you know, that's kind of where you get to about the 5 to 6 categories. Those are kind of where I think of more of the drugs that are targeted towards, you know, atopic dermatitis. So, we have a variety of them. Realistically, you go looking at Cytopoint, which is the monoclonal antibody to [interleukin 31] IL-31, which is [an] injectable, canonized as well I should say, so it's only for dogs. I think it works really well. It's variable how long it works. You know, anywhere from 4 to 8 weeks can be successful for that and the nice thing is, you take out the compliance from the owner. It's an injectable you give there at the clinic and it's going to be good as far as that timeline, and you don't have to worry about the owner missing pills or not giving drugs or something like that. 

Next kind of category I usually think of is kind of your Jak inhibitors. So the Jak inhibitors, would include both Apoquel, as well as Zenrelia. There's a little bit of differences between the two. Obviously, Apoquel has been out quite a while for that drug, and pretty successful, as far as, you know, how long it's been out—anywhere from 60% to 80%, I think it depends on how severe the disease is for [the] success rate for those. But it has been highly successful, relatively safe I would say for the most part, little bit of side effects here and there, but overall, I think it's relatively safe.

Zenrelia is a newer drug. I mean, it was approved by the FDA in September 2024. The biggest concern with it is it does have a black box warning around vaccinations and suppression and whatnot, but they've done some further studies with vaccination, showing that dogs that have previously been vaccinated and are getting then booster vaccines are easily able to achieve tighter levels for the distemper and rabies vaccine. And those were done in much larger studies: 4 times the quantity of dogs [than in] the initial study…. So, from that aspect, I think it's very safe—I'm not worried about the vaccines aspect with them. I think it's relatively safe there. Side effects, since it's also in kind of that Jak inhibitor category and kind of that same first generation of them, I believe that the side effects are relatively low. I have yet to see a side effect with those dogs either. So, I think it's same category for them.

Obviously, we always have steroids. Steroids work well, you know I kind of consider all 4 of those drugs as fast acting, and steroids are kind of in there. Steroids are like a silver bullet. They're highly successful, but long term, my absolute last option because of the side effects and you're definitely going to cause some health issues long term.

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Jason B. Pieper, DVM, MS, DACVD, talks about the multiple therapies available for cases of moderate and severe atopic dermatitis and delves into each option

The US Department of Agriculture (USDA), Center for Veterinary Biologics (CVB), issued Zoetis a conditional license for its Avian Influenza Vaccine, H5N2 Subtype, Killed Virus. The vaccination, labeled for use in chickens, was granted the conditional license because its serology data showed it demonstrates safety, purity, and has a reasonable expectation of efficacy

“When a new strain of HPAI was identified in the US in early 2022, our scientists immediately began work to update our previous avian influenza vaccine,” said Mahesh Kumar, PhD, senior vice president, global biologics research and development at Zoetis, in an organizational release.

On February 8, 2022, the USDA Animal and Plant Health Inspection Service (APHIS) confirmed highly pathogenic avian influenza (HPAI) was detected in a commercial flock in the United States.

 The virus has continued to spread to other species, including dairy cattle, and even human cases are beginning to be reported. At this time, APHIS has confirmed 146 flocks with HPAI, after being tested, with 94 being commercial flocks, 47 backyard flocks, and a total of 20.04 million birds confirmed infected.

From poultry to public health: Understanding the H5N1 threat

A USDA conditional license, like Zoetis’ avian influenza vaccine

H5N2 Subtype, Killed Virus, allows a product to be used to meet an emergency condition, limited market, local situation, or any other special circumstance and is issued for a finite period, and can be renewed at the discretion of the CVB.

In 2016, Zoetis had received a conditional license for its H5N1 vaccine as well as a contract award for the USDA’s National Veterinary Stockpile. The vaccination was then used in 2023 by the US Fish & Wildlife Service to help protect California condors. Additionally, Zoetis has a USDA license for POULVAC FLUFEND i AI H5N3 RG, which is available in smaller markets outside of the United States, and was used in 2024 to protect endangered birds in New Zealand.

“We first worked on HPAI vaccines in 2001-02 when outbreaks occurred in flocks in Southeast Asia. Our readiness with this most recent vaccine is another example of how we continue to live our purpose to nurture the world and humankind by advancing care for animals, ultimately providing solutions to global animal health challenges,” Kumar continued.

Zoetis Receives Conditional License from USDA for Avian Influenza Vaccine, H5N2 Subtype, Killed Virus, for Chickens. News release. February 14, 2025. Accessed February 17, 2025. 

https://news.zoetis.com/press-releases/press-release-details/2025/Zoetis-Receives-Conditional-License-from-USDA-for-Avian-Influenza-Vaccine-H5N2-Subtype-Killed-Virus/default.aspx

HPAI Confirmations in Commercial and Backyard Flocks. US Department of Agriculture Animal and Plant Health Inspection Service. Accessed February 17, 2025. https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-detections/commercial-backyard-flocks

Articles

The vaccine from Zoetis, Avian Influenza Vaccine, H5N2 Subtype, Killed Virus, is for poultry and has been demonstrated to be safe, pure, and to have a reasonable expectation of efficacy

USDA issues conditional license for H5N2 vaccination 

Canine oral cavity masses are commonly identified, often as an incidental finding during dental prophylaxis or because of clinical signs identified by owners. Clinical signs can include foul odor from the mouth, abnormal or altered prehension or eating patterns, hypersalivation, blood in the water or food bowls, or a grossly visible mass. These masses can range from inflammatory lesions to hyperplastic lesions to benign or malignant neoplastic diseases. As such, prognosis and treatment recommendations vary based on the type of lesion identified.

Several important steps should be taken and/or considered after the identification of an oral cavity lesion:

Perform a thorough oral examination. This is best performed with the canine under heavy sedation and/or anesthesia.

Document the location of the mass in the medical record as per the modified Triadan system, including details on the location of the mass relative to the teeth (buccal or lingual/palatal) or other pertinent anatomic structures.

Consider taking digital photographs. Because of the complexity of oral cavity masses, digital photographs of the mass are recommended as part of the medical record. This may be of particular importance if the mass requires a more extensive surgical excision following definitive diagnosis.

Perform diagnostic tests aimed at identifying the origin of the oral cavity mass to guide treatment recommendations and prognostic discussions 

Diagnostic investigation of oral cavity lesions typically begins with direct sampling of the lesion to determine a benign or malignant behavior. Cytological evaluation via fine-needle aspiration or impression smears can be a minimally invasive option to achieve a diagnosis and has a high level of agreement with histologic diagnoses.

However, when aiming for a potential definitive treatment, clinicians may prefer to perform incisional or excisional biopsies. The previously mentioned documentation recommendations are of particular importance if excisional biopsies are being considered. If a definitive diagnosis of a malignant tumor or a benign but locally invasive tumor is made, further treatment may be required. Because there may be no gross disease visible to guide additional diagnostics and treatments, the previous documentation will be an important guide to ensure the correct location is being evaluated and treated.

The overall incidence of canine oral tumors is higher than previously reported2 and may be attributed to improved medical care for pets and to pet insurance, resulting in more animals receiving routine medical care than in the past. Canine oral tumors make up approximately 6% to 7% of all reported canine neoplasms

 and tend to be malignant more often than benign.

 The most common oral tumors in dogs are melanoma, squamous cell carcinoma (SCC), fibrosarcoma, and acanthomatous ameloblastoma, and the most common site for oral tumors in dogs is the gingiva,

 with some tumors having additional site predilections or locations.

The most common canine oral tumor types and their site/location predilections are as follows

Melanoma—gingiva, buccal or lingual mucosa

Fibrosarcoma—maxillary gingiva, hard palate

Acanthomatous ameloblastoma—rostral mandible

Although melanoma, SCC, and fibrosarcoma exhibit malignant behavior, acanthomatous ameloblastomas have a benign but locally invasive behavior pattern.

 Metastatic potential is highest for melanoma cases, with a lower rate of metastasis for SCC and fibrosarcoma and no reported metastases for acanthomatous ameloblastoma cases.3 Despite the lack of metastatic potential for acanthomatous ameloblastomas, their local invasion into the surrounding bone results in diagnostic investigation and surgical treatments similar to those for malignant tumors.

After a definitive diagnosis of any of these tumors, additional diagnostic investigations are recommended. Typically, this includes advanced imaging of the skull to assess the local extent of disease to aid in surgical planning and investigations aimed to rule out regional and distant metastases, such as local lymph node aspiration and thoracic imaging. Surgical treatment for these most common tumors of the mandible and maxilla entails a regional mandibulectomy or maxillectomy. Despite the gross soft tissue nature of these masses, excision of the underlying bone is required due to the tissues of origin of these tumors, invasion of local bone, and the increased risk for local recurrence when soft tissues only are excised.

Despite a relatively invasive surgical treatment process, many dogs recover well from surgery and return to normal oral functions, including prehension, mastication, and drinking.

 Partial mandibulectomies and maxillectomies can have minimal impact on cosmesis, depending on the site and extent of disease, and owners have reported both formally

 and anecdotally that their pet’s quality of life is good postoperatively. Because the invasiveness of definitive treatment for oral tumors can often affect owners’ decision-making, veterinarians are encouraged to highlight the good quality of life, minimal cosmetic alteration, and reasonable recovery times postoperatively during these discussions.

Katie Hoddinott, DVM, DVSc, BSc, DACVS-SA

, is a native of Nova Scotia, Canada. She graduated with her DVM from the Atlantic Veterinary College, University of Prince Edward Island, in 2012. She then completed 2 internships and a surgery residency at the Ontario Veterinary College, University of Guelph. She became a diplomat of the American College of Veterinary Surgeons – Small Animal in 2019. Hoddinott is currently working at the Atlantic Veterinary College as an assistant professor in small animal surgery, where she enjoys teaching undergraduate veterinary students, interns, and residents. Her professional interests lie mainly in surgical oncology and minimally invasive soft tissue surgery. Her current research focuses include advances in clinical teaching for surgery residents and surgical site infections.

Bonfanti U, Bertazzolo W, Gracis M, et al. Diagnostic value of cytological analysis of tumours and tumour-like lesions of the oral cavity in dogs and cats: a prospective study on 114 cases. 

. 2015;205(2):322-327. doi:10.1016/j.tvjl.2014.10.022

Cray M, Selmic LE, Ruple A. Demographics of dogs and cats with oral tumors presenting to teaching hospitals: 1996-2017. 

. 2020;21(5):e70. doi:10.4142/jvs.2020.21.e70

Liptak JM, Withrow S. Oral tumors. In: Kudnig ST, Séguin B, eds. 

Satthathum C, Srisampane S, Jariyarangsrirattana P, Anusorn P, Sattasathuchana P, Thengchaisri N. Characteristics of canine oral tumors: insights into prevalence, types, and lesion distribution. 

. 2023;10(3):554-562. doi:10.5455/javar.2023.j709

Bull I, Ziener ML, Storli SH, Arendt ML. Quality of life after partial mandibulectomy or maxillectomy in 45 dogs with oral tumors. 

 2023;40(4):329-337. doi:10.1177/08987564231164483

The type of lesion will guide treatment and prognosis

Managing canine oral tumors

The field study for Laverdia-CA1’s (verdinexor tablets) safety and effectiveness in dogs with lymphoma has been completed, according to Anivive, a software-driven pet health company behind the drug’s development. Laverdia-CA1, which received conditional approval from the FDA in 2021, presents a promising oral treatment option for canine lymphoma as it offers a non-invasive approach for veterinary oncology patients, according to a news release.

For the study, 150 dogs were chosen to participate in the trial from more than 700 applicants. The study was a randomized, placebo-controlled, double-masked study that was conducted throughout 12 clinical sites in the United States. Patient treatment and data collection concluded with the closure of the final study site on December 12, 2024, according to Anivive.

With data collection now finished, Anivive has locked the database to start statistical analysis. Results are anticipated in the coming months. The company plans to submit the Effectiveness technical section of the new animal drug application for regulatory review this summer. The FDA has already deemed all other major sections of the application complete, according to Anivive.

 The company will also be submitting for full approval of the drug in Brazil, Australia, the United Kingdom, and the European Union once the data package is finalized.

“This achievement represents a key milestone in Anivive's mission to deliver innovative cancer treatments to companion animals, such as this new first-in-class XP01 blocker,” wrote the company in a news release.

"The completion of our critical study for LAVERDIA-CA1 marks a major milestone in bringing forward an innovative therapy for canine lymphoma,” Dylan Balsz, CEO of Anivive, said in the release.

 "We are excited to analyze the data and move closer to making an oral treatment option available for dogs living with this challenging disease."

In 2021, Laverdia-CA1 became the first conditionally approved oral treatment for dogs with lymphoma. The drug prevents certain proteins from leaving the nucleus of cancer cells, in turn helping these proteins control the growth of cancerous cells in dogs and prevent their spread.

 It is administered orally twice a week with at least 72 hours between doses.

When handling Laverdia-CA1 and cleaning up after a treated dog, and for 3 days post-treatment, veterinarians should wear gloves tested for use with chemotherapy drugs. Cases where gloves should be worn include handling the patient’s food and water bowls, and the patient’s feces, urine, vomit or saliva.

Owners of dogs with lymphoma can also administer the drug at home with a veterinarian prescription and client information sheet.

According to the FDA, pregnant women, women who may become pregnant, nursing women, and children should not handle or administer Laverdia-CA1 nor touch the feces, urine, vomit or saliva of treated dogs.

 with dvm360, Craig A Clifford, DVM, MS, DACVIM (Oncology), offered insight on the novel drug. “We know for the average dog, it may hold the disease for about 3 months or so, so [the drug is] not meant to be a silver bullet—a cure-all for lymphoma,” he explained.

 “[Most] likely in the future, oncologists will be combining it with other agents in other types of protocols. But to me, knowing that 80% of lymphomas are left untreated, [the drug] gives the primary care a game changer—something else that they can utilize, other than just prednisone.”

According to Clifford, veterinary oncologists are beginning to see that Laverdia-CA1 also has a very high response rate against T cell lymphoma—a rare form of cancerous lymphoma that is challenging to treat with few drugs that treat it available. “We’re starting to see that there may be other avenues for this agent,” said Clifford.

“Right now, I view it more as a primary care drug, and I think that’s great because to me, we’re expanding access, meaning more cases are going to get treated, and it’s an unmet need, and I think this drug checks both of those boxes,” he concluded.

Anivive announces completion of Laverdia®-CA1 pivotal field study for canine lymphoma. News release. Anivive Lifesciences Inc. February 14, 2025. Accessed February 14, 2025. 

https://prnmedia.prnewswire.com/news-releases/anivive-announces-completion-of-laverdia-ca1-pivotal-field-study-for-canine-lymphoma-302377090.html

FDA conditionally approves first oral tablet to treat lymphoma in dogs. News release. US Food and Drug Administration. January 11, 2021. Accessed February 14, 2025. 

https://www.fda.gov/news-events/press-announcements/fda-conditionally-approves-first-oral-tablet-treat-lymphoma-dogs

Bautista-Alejandre A, Clifford C. About the novel drug for canine lymphoma. 

. January 6, 2025. Accessed February 14, 2025. 

https://www.dvm360.com/view/about-the-novel-drug-for-canine-lymphoma

Most major sections of the new animal drug application for Laverdia-CA1 have been deemed complete by the FDA, bringing the drug closer to approval

Laverdia-CA1's field trial ends, statistical analysis to begin 

Happy Friday dvm360 readers! We hope that everyone had a great week and are ready for the weekend. Did you know that we are almost officially 1 month away from our first Fetch conference of the year, 

? Join us in the Queen’s City for a weekend full of educational lectures from the best faculty around, networking opportunities with fellow professionals, and more! This is a conference you do not want to miss, so register here today!

Here is what was popular this week on dvm360.com:

The US Department of Agriculture (USDA) Animal and Plant Health Inspection (APHIS) 

 that dairy cattle in Nevada have been confirmed to have the H5N1 clade 2.3.4.4b genotype D1. 1, making it the first case of this genotype found in dairy cattle.

 the launch of AI Masses, the latest addition to its Vetscan Imagyst platform. This addition will use artificial intelligence to perform quick clinical screenings of common lymph node and subcutaneous lesion at the point of care.

 of The Vet Blast Podcast presented by dvm360, Kemba L. Marshall, MPH, DVM, DABVP (Avian), shared more about her book 

Diversity, Equity, and Inclusion in Veterinary Medicine 

with our host Adam Christman, DVM, MBA, including what inspired her to become an author. dvm360 and Marshall have also partnered together for a giveaway of her book, so head over to 

, has been reintroduced in Congress. The bill, endorsed by the American Veterinary Medical Association, will categorize xylazine as a Schedule III controlled substance and provide protection to animal care professionals that prescribe and administer it.

Bison and cattle imports from Mexico are set to resume soon, according to USDA APHIS, after pausing shipments in November 2024 due to 

 being detected in cattle in Mexico. APHIS and Mexico will be implementing extensive protocols for pre-clearance inspections and treatment.

Wrap up: Cattle and bison imports from Mexico to resume under new screwworm inspection protocol, and other news

A new, generic, non-steroidal anti-inflammatory drug (NSAID) is now available for managing osteoarthritis (OA) pain in horses. Aurora Pharmaceutical’s EquiCoxib is bioequivalent to the Equioxx brand oral paste (Boehringer Ingelheim) using firocoxib as the active ingredient.

Approved by the FDA in January 2024, EquiCoxib is a noninvasive, liquid formulation. The FDA permitted the application for EquiCoxib approval to differ in dosage form and strength from the brand product. An in vivo blood-level study in horses was conducted to demonstrate that the 9.0 mg/mL EquiCoxib oral solution is bioequivalent to the 8.2 mg/g Equioxx oral paste. Based on study data submitted to the FDA by Aurora Pharmaceutical, the agency determined that EquiCoxib is safe and effective when used according to its’ label.

EquiCoxib is indicated for oral administration once a day for up to 14 days in equine patients, and should not be injected. This therapy is available by prescription from a licensed veterinarian, and should not be used with other NSAIDs, corticosteroids or nephrotoxic medication.

"EquiCoxib is [a]… cost-effective option that doesn't compromise quality," Mike Strobel, DVM, MS, founder and CEO of Aurora Pharmaceutical, said in a news release.

 "We're excited to share our latest offering to horse owners and their veterinarians."

Aurora Pharmaceutical specializes in developing, manufacturing, and distributing animal health products. Based in Northfield, Minnesota, the company aims to serve veterinarians, livestock producers, and pet owners.

With EquiCoxib, Aurora Pharmaceutical is advising veterinarians to provide a client information sheet to the patient’s owner with every prescription and refill. Veterinary professionals and client should be aware of potential risks associated with firocoxib, and clients should also be advised to observed for signs of potential drug toxicity, according to the company.

The most common adverse effects associated with EquiCoxib include erosions and ulcers of the gums, tongue, lips and face, and kidney problems. As a NSAID, EquiCoxib may be associated with gastrointestinal, hepatic and renal toxicity. Additional adverse reactions of firocoxib use in horses may also include weight loss, colic, diarrhea, or icterus. Aurora Pharmaceutics recommends that veterinary teams advise clients to discontinue NSAID therapy and contact their veterinarian immediately if any adverse signs of intolerance are observed.

Aurora Pharmaceuticals delivers on FDA-approved generic for equine pain relief. Aurora Pharmaceuticals. February 13, 2025. Accessed February 14, 2025. 

https://prnmedia.prnewswire.com/news-releases/aurora-pharmaceutical-delivers-on-fda-approved-generic-for-equine-pain-relief-302376438.html

Freedom of information summary: ANADA 200-766. FDA. January 11, 2024. Accessed February 14, 2025. 

https://aurorapharmaceutical.com/wp-content/uploads/2024/03/FOI-Summary-oA-200-766-Approved-January-11-2024.pdf

EquiCoxib (firocoxib) oral solution for horses. Aurora Pharmaceuticals. Accessed February 14, 2025. 

https://aurorapharmaceutical.com/wp-content/uploads/2024/07/EquiCoxib-Product-Insert.pdf

Approved by the FDA in January 2024, EquiCoxib is a noninvasive, liquid formulation.