Development of a core outcome set for therapeutic clinical trials enrolling dogs with atopic dermatitis (COSCAD'18)

Establishment of clinical criteria for the diagnosis of adverse food reactions in dogs with atopic dermatitis

BACKGROUND

Diagnosis of canine adverse food reactions (AFRs) is based on vague criteria, such as '>50% improvement' during elimination diet trial (EDT) followed by 'deterioration' during provocation test (PT).

OBJECTIVE

The objective of the study was to use predefined criteria to evaluate response during EDT [i.e., Owner Global Assessment of Treatment Efficacy (OGATE) = good-to-excellent] and relapse during PT [i.e., Owner Global Assessment of Challenge Deterioration (OGACD) = moderate-to-severe and/or >100% increase of lesional (Canine Atopic Dermatitis Extent and Severity Index, 4th iteration, CADESI-04) and/or of pruritus (pruritus Visual Analog Scale, PVAS) scores].

ANIMALS

Twenty-nine dogs with atopic dermatitis.

MATERIALS AND METHODS

An extensively hydrolysed diet was fed to all dogs followed, in seven of 11 nonresponders, by a second home-made novel-protein EDT. Dogs responding to either EDT were challenged with their previous diet.

RESULTS

Thirteen (44.8%) dogs were diagnosed with AFRs: at the end of EDT, their OGATE was good (9 of 13; 69.2%) or excellent (four of 13; 30.8%), and both CADESI-04 (46.7%) and PVAS (71.1%) had decreased significantly; at the end of PT, OGACD was moderate or severe in 12 of 13 (92.3%) dogs, and both CADESI-04 (127.9%) and PVAS (181.8%) had increased significantly. Of the 16 dogs without AFRs, 6 (37.5%) responded to the commercial (n = 5) or home-made (n = 1) diet [OGATE = good (three of six) or excellent (three of six)], with significant concurrent reduction of CADESI-04 and nonsignificant reduction of PVAS, yet they did not relapse during PT.

CONCLUSIONS AND CLINICAL RELEVANCE

The proposed (predefined) criteria for the evaluation of response during EDT and deterioration during PT seem reliable and are easily applicable in clinical practice and research.

Are images worth a thousand words? A preliminary study testing a video for owner education in canine atopic dermatitis

BACKGROUND

Successful management of canine atopic dermatitis (cAD) is challenging and effective pet owner education is crucial to successful outcomes. However, there are limited proven educational strategies in this area. Our goal was to create an effective and engaging educational tool for owners of dogs with cAD.

HYPOTHESIS

Video-based education efficacy would be comparable to traditional verbal delivery. Secondary objectives included assessing client perception of the intervention, and determining if there were clinical benefits for the dogs and improved client adherence to treatment.

SUBJECTS

Twenty-nine dogs with cAD and their owners were recruited from a teaching hospital of a European veterinary medicine faculty.

MATERIALS AND METHODS

In this 8 week, prospective, randomised controlled study, clients in the control group (CG, n = 13) received verbal education and those in the intervention group (IG, n = 16) watched a video. Client knowledge was assessed at Day (D)0 and D56. Treatment adherence and perceived utility and appeal ratings were measured at D56. Clinical progress was assessed at D0 and D56 using CADESI-04 and PVAS10.

RESULTS

The differences found in the means of cAD knowledge score, clinical outcomes, utility and appeal ratings and owners' adherence score between groups were not statistically significant. A significant association between the outcome and the intervention group concerning education success [CG, six of 13 (46.15%); IG, 15 of 16 (93.75%)] was found (p = 0.01).

CONCLUSIONS AND CLINICAL RELEVANCE

Video-based instructions positively impacted owners' education and demonstrated their potential as a valuable tool. The authors believe that video-based education could be a time-efficient alternative for initial cAD education in veterinary clinics.

A Randomized Controlled Trial to Evaluate the Impact of a Novel Probiotic and Nutraceutical Supplement on Pruritic Dermatitis and the Gut Microbiota in Privately Owned Dogs

Pruritic dermatitis (PD) is a common presentation of canine allergic skin diseases, with diversity in severity and treatment response due to complex etiopathogenesis. Evidence suggests the gut microbiota (GM) may contribute to the development of canine allergies. A 10-week double-blind randomized controlled trial evaluated a novel probiotic and nutraceutical blend (PNB) on clinical signs of skin allergy, health measures, and the GM of privately owned self-reported pruritic dogs. A total of 105 dogs were enrolled, with 62 included in pruritus and health analysis and 50 in microbiome analysis. The PNB supported greater improvement of owner-assessed clinical signs of PD at week 2 than the placebo (PBO). More dogs that received the PNB shifted to normal pruritus (digital PVAS10-N: <2) by week 4, compared to week 7 for the PBO. While a placebo effect was identified, clinical differences were supported by changes in the GM. The PNB enriched three probiotic bacteria and reduced abundances of species associated with negative effects. The PBO group demonstrated increased abundances of pathogenic species and reduced abundances of several beneficial species. This trial supports the potential of the PNB as a supplemental intervention in the treatment of PD; however, further investigation is warranted, with stricter diagnostic criteria, disease biomarkers and direct veterinary examination.

Efficacy and tolerance of a novel topical TRPV-1 channel antagonist in dogs with allergic pododermatitis

BACKGROUND

Pruritus due to allergic skin disease is one of the most common reasons for dermatological consultations in the veterinary clinic. Treatment is usually multimodal and requires continuous monitoring and reassessment. New therapies are needed to broaden the therapeutic arsenal.

HYPOTHESIS/OBJECTIVES

The aim of this study was to evaluate the efficacy of a novel transient receptor potential vanilloid 1 (TRPV1) channel antagonist for allergic pododermatitis in dogs.

ANIMALS

Twenty-four client-owned dogs with allergic pododermatitis.

MATERIALS AND METHODS

The study was an open, prospective, multi-centre clinical trial with client-owned dogs. All dogs were treated twice daily with a spray containing hydroxymethoxyiodobenzyl glycolamide pelargonate for 28 days. Clinical assessments included pruritus Visual Analog Scale (PVAS), pedal skin lesion score, evaluation of quality of life (QoL), presence of secondary infections and a four-point subjective efficacy assessment by the veterinarian and the dog owner.

RESULTS

There was more than 50% improvement in all scores by the conclusion of the study. Secondary infections were reduced (p < 0.001). Both the veterinarians and dog owners evaluated the efficacy of the product positively. The product was well-tolerated.

CONCLUSIONS AND CLINICAL RELEVANCE

This study demonstrated the tolerability and efficacy of a TRPV1 antagonist on pruritic pododermatitis in 24 dogs.

Primary Prevention of Canine Atopic Dermatitis: Breaking the Cycle-A Narrative Review

Canine atopic dermatitis (cAD) is a common and distressing skin condition in dogs, affecting up to 30% of the canine population. It not only impacts their quality of life but also that of their owners. Like human atopic dermatitis (hAD), cAD has a complex pathogenesis, including genetic and environmental factors. Current treatments focus on managing clinical signs, but they can be costly and have limitations. This article emphasizes the importance of preventing cAD from developing in the first place. Understanding the role of the skin's protective barrier is crucial, as its dysfunction plays a vital role in both hAD and cAD. hAD prevention studies have shown promising results in enhancing the skin barrier, but more research is needed to support more robust conclusions. While hAD primary prevention is currently a focal point of intensive investigation in human medicine, research on cAD primary prevention remains under-researched and almost non-existent. Pioneering effective prevention strategies for cAD holds immense potential to enhance the quality of life for both dogs and their owners. Additionally, it bears the promise of a translational impact on human research. Hence, further exploration of this crucial topic is not only relevant but also timely and imperative, warranting support and encouragement.

Efficacy and Safety of Subcutaneous Allergen-Specific Immuno-Therapy in Horses with Allergic Cutaneous and Respiratory Diseases-A Systematic Review

Allergen-specific immunotherapy (AIT) is the only current intervention that has the ability to modify the immune response toward a tolerogenic state. This study aimed to assess the efficacy and safety of AIT in horses with allergic diseases in a systematic manner. Three databases were searched to identify articles reporting clinical outcomes and adverse events associated with AIT. The articles were evaluated for beneficial responses to AIT, defined as a ≥50% reduction in clinical signs, and clinical remission. Horses with respiratory diseases, urticaria, and pruritic dermatitis receiving insect monotherapy or multi-allergen AIT were included. All adverse events were graded, and analytical and confounding biases were assessed. The results showed that multi-allergen AIT had a beneficial response in 75% of horses with respiratory diseases, 88% with urticaria, and 56% with pruritic dermatitis. However, horses treated solely with insect AIT for pruritic dermatitis had a lower response rate (36%). Self-limiting local reactions were the most common adverse events, with systemic reactions grade II accounting for 11% of reported events. Analytical and confounding biases were identified as major limitations in the available studies. Further research is needed to address these biases and provide stronger evidence on the efficacy and safety of AIT in horses with allergic diseases.

High-frequency ultrasound biomicroscopy findings of the skin of dogs with atopic dermatitis

BACKGROUND

The high-frequency ultrasonographic appearance of skin of dogs with atopic dermatitis (cAD) has not been described.

OBJECTIVES

To compare high-frequency ultrasonographic findings among lesional, macroscopically nonlesional skin of dogs with cAD, and the macroscopically nonlesional skin of healthy dogs. Additionally, to determine whether there is any correlation between the ultrasonographic findings in lesional skin and local Canine Atopic Dermatitis Extent and Severity Index, 4th iteration (CADESI-04) or its domains (erythema, lichenification, excoriations/alopecia). As a secondary aim, six cAD dogs were re-evaluated after management intervention.

ANIMALS

Twenty dogs with cAD (six were re-examined after treatment) and six healthy dogs.

MATERIALS AND METHODS

In all dogs, ultrasonographic examination was performed on the same 10 skin sites, using a 50 MHz transducer. Wrinkling of skin surface, presence/width of subepidermal low echogenic band, hypoechogenicity of dermis and thickness of the skin were evaluated and scored/measured blindly.

RESULTS

Dermal hypoechogenicity was more common and severe in lesional compared to macroscopically nonlesional skin of dogs with cAD. In lesional skin, presence/severity of wrinkling of skin surface and of dermal hypoechogenicity were positively correlated with presence/severity of lichenification, while severity of dermal hypoechogenicity was positively correlated with local CADESI-04. A positive correlation between the change in skin thickness and the change in the severity of erythema during treatment was noted.

CONCLUSIONS AND CLINICAL RELEVANCE

High-frequency ultrasound biomicroscopy may be useful for the evaluation of skin of dogs with cAD and for evaluating the progression of skin lesions during treatment.

A randomised, double-blinded comparison between subcutaneous rush and intralympathic allergen immunotherapy induction in atopic dogs

BACKGROUND

Atopic dermatitis (AD) is one of the most common skin diseases in small animal practice. Allergen immunotherapy (AIT) is the only curative treatment for the disease, and oral, subcutaneous and intralymphatic administration of allergens are commonly employed.

OBJECTIVES

To compare the efficacy of AIT following an induction phase with intralymphatic injections (ILIT) or rush immunotherapy (RIT).

ANIMALS

Fifty privately owned dogs with AD.

MATERIALS AND METHODS

In a double-blinded study, dogs were randomly assigned to either four monthly ILIT of allergen extract or RIT with five injections administered subcutaneously at hourly intervals on the first day. They were assessed by validated scores; Canine Atopic Dermatitis Lesion Index (CADLI) and pruritus Visual Analog Scale (PVAS) at the beginning of the study and after 1, 3, 6 and 12 months. The latter were performed daily for 7 days before each revisit. Medication scores and a total clinical score were calculated and compared between each group and time point.

RESULTS

There was no significant difference in CADLI and PVAS scores, or CADLI and medication scores between groups at any of the time points. A significant improvement with both ILIT and RIT was seen in total and pruritus scores, respectively. An owner global assessment of good-to-excellent treatment efficacy was seen in 40% of the dogs; total scores improved by 27% and 35% in the RIT and ILIT group, respectively. Adverse effects were not seen.

CONCLUSIONS AND CLINICAL RELEVANCE

Induction of AIT can be conducted either as RIT or ILIT with no loss in efficacy.

A randomised controlled trial testing the rebound-preventing benefit of four days of prednisolone during the induction of oclacitinib therapy in dogs with atopic dermatitis

BACKGROUND

A rebound of pruritus occasionally occurs after oclacitinib dose reduction in dogs with atopic dermatitis (AD).

OBJECTIVES

To determine whether an initial 4-day course of prednisolone decreases the probability of a pruritus rebound after reducing the frequency of oclacitinib administration.

ANIMALS

Forty dogs with mild-to-moderate AD lesions and moderate-to-severe pruritus.

MATERIALS AND METHODS

Dogs were randomised to receive oclacitinib at 0.4-0.6 mg/kg twice daily for 14 days then once daily, alone or with prednisolone at 0.5 mg/kg, orally, twice daily for the first 4 days. Clinicians graded the Canine Atopic Dermatitis Extent and Severity Index (CADESI)4 and 2D-investigator global assessment (IGA) before and after 28 days; owners assessed the pruritis Visual Analog Scale (PVAS)10 and Owner Global Assessment of Treatment Efficacy (OGATE) on Day (D)0, D4, D14, D21 and D28. We considered a rebound any increase greater than one PVAS10 grade at D21 compared to D14.

RESULTS

On D21, there were significantly fewer rebounds in the dogs receiving prednisolone (three of 20, 15%) compared to those given oclacitinib alone (nine of 20, 45%; Fisher's test, p = 0.041). Compared to oclacitinib monotherapy, the concurrent administration of prednisolone for the first 4 days led to significantly lower PVAS10 on D4 and D28, CADESI4 and 2D-IGA on D28, and OGATE on D21 and D28 (Wilcoxon-Mann-Whitney U-tests). Adverse effects of therapy were minor, intermittent and self-resolving.

CONCLUSIONS AND CLINICAL RELEVANCE

The initial addition of 4 days of prednisolone significantly decreased the probability of a rebound of pruritus 1 week after oclacitinib dose reduction. This short concomitant glucocorticoid administration led to a higher skin lesion improvement and improved perception of treatment efficacy with minimal adverse effects.

The standards of reporting trials in pets (PetSORT): Explanation and elaboration

Well-designed randomized controlled trials (RCTs) provide the best evidence of the primary research designs for evaluating the effectiveness of interventions. However, if RCTs are incompletely reported, the methodological rigor with which they were conducted cannot be reliably evaluated and it may not be possible to replicate the intervention. Missing information also may limit the reader's ability to evaluate the external validity of a trial. Reporting guidelines are available for clinical trials in human healthcare (CONSORT), livestock populations (REFLECT), and preclinical experimental research involving animals (ARRIVE 2.0). The PetSORT guidelines complement these existing guidelines, providing recommendations for reporting controlled trials in pet dogs and cats. The rationale and scientific background are explained for each of the 25 items in the PetSORT reporting recommendations checklist, with examples from well-reported trials.

Palmitoyl-glucosamine co-micronized with curcumin for maintenance of meloxicam-induced pain relief in dogs with osteoarthritis pain

BACKGROUND

Osteoarthritis (OA) pain is the number one cause of chronic pain in dogs. Multimodal treatment, including combining safe and effective nutritional interventions with non-steroidal anti-inflammatory drugs (NSAIDs), is currently considered one of the most appropriate choices for managing OA pain. Palmitoyl-glucosamine is a feed material belonging to the ALIAmide family, whose parent molecule is the prohomeostatic lipid amide N-palmitoyl-ethanolamine. Curcumin is a promising plant antioxidant. The present study aimed at investigating whether 18-week dietary integration with palmitoyl-glucosamine co-micronized with curcumin was able to maintain pain relief in dogs with OA-associated chronic pain receiving meloxicam (1.5 mg/ml oral suspension) on a tapering regimen (progressive 25% decrease of the original 0.1 mg/kg/day dose, on a biweekly basis) during the first 8 weeks of treatment. Pain was assessed both by the owners and veterinary surgeons, with the first using both subjective evaluation and validated metrology instruments-i.e., Helsinki Chronic Pain Index (HCPI) and Canine Brief Pain Inventory (CBPI)-while the second rating the severity of lameness and pain on palpation on two previously used 5-point scales.

RESULTS

A total of fifty-eight dogs with OA chronic pain entered the uncontrolled study. Pain on HCPI was considered severe at baseline (range 18-39). Based on owner's assessment, 90% of dogs who responded to meloxicam at the full-dose regimen could reduce meloxicam up to 25% of the original dose without experiencing pain worsening. Moreover, 75% of dogs was assessed as having no pain increase ten weeks after meloxicam withdrawal. A statistically significant decrease of pain severity as scored by HCPI (P < 0.0001) was observed two and ten weeks after meloxicam withdrawal compared to study entry (17.0 ± 1.05 and 15.1 ± 1.02, respectively, vs 29.0 ± 0.74; mean ± SEM). After meloxicam withdrawal, no statistically significant change in the CBPI scores was recorded. Pain on palpation and lameness significantly changed to less severe distributions along the study period (P < 0.0001).

CONCLUSION

The findings appear to suggest that dietary integration with palmitoyl-glucosamine co-micronized with curcumin was able to maintain meloxicam-induced pain relief in dogs with severe OA chronic pain.

Maximizing value and minimizing waste in clinical trials in swine: Selecting outcomes to build an evidence base

Researchers planning clinical trials should identify the primary trial outcome and adequately power the trial to detect clinically meaningful differences in this outcome. All primary and secondary outcomes and their measurement should be comprehensively described, and their results reported. There is evidence that trials on the same subject use different outcomes or measure the same outcome in different ways, making it difficult to compare intervention effectiveness across clinical trials. Consensus development of core outcome sets could improve consistency in outcome measures used across trials and aid in development of an evidence-based body of literature on intervention effectiveness in swine populations.

Efficacy of Antimicrobial Treatment in Dogs with Atopic Dermatitis: An Observational Study

There is a shortage of studies reporting the efficacy of antimicrobial treatment of dogs with atopic dermatitis (AD) and skin infections (SIs). The aim of this study was to evaluate the change in the severity of skin lesions and pruritus, and the overall efficacy of antimicrobial treatment, in dogs with AD and bacterial overgrowth/infection and/or Malassezia dermatitis. A total of 20 dogs with AD and SIs were prospectively enrolled (group A) and they were examined before and after the administration of systemic antimicrobials that resulted in the resolution of SIs. In addition, 19 dogs fulfilling the same inclusion criteria and treated with systemic, with or without topical antimicrobials, were included retrospectively (group B). Since there were no major differences between the groups, their results were combined. The severity of skin lesions decreased significantly, by 30% based on Canine Atopic Dermatitis Extent and Severity Index-4 (CADESI-4), by 28.1% based on the erythema domain of CADESI-4 and based on owner’s global assessment of the severity of skin lesions. Pruritus decreased significantly, by 34.7% based on the Pruritus Visual Analogue Scale (PVAS). The efficacy of antimicrobial treatment was assessed as good to excellent by the investigator and the owner in 55% and 60% of the dogs, respectively. Despite the significant improvement, there was high variability in the response to treatment among dogs. Further studies are needed to find factors that determine the response to antimicrobial treatment in dogs with AD and SIs.

Use of Cytopoint in the Allergic Dog

Allergic dermatitis is the most common type of skin disease in dogs. Of all dogs, 20 to 30% present with some type of allergic dermatitis. Pruritus is one of the most important signs of allergic dermatitis and is often the most challenging to control. Interleukin-31 (IL-31) has been found to be one of the main initiators of pruritus in dogs with allergic dermatitis. Cytopoint®, a caninized monoclonal anti-IL-31 antibody, has been shown to be effective for the treatment of dogs against allergic dermatitis and atopic dermatitis. US label indication. A recent retrospective study reported that Cytopoint achieved treatment success in 87.8% of the cases with allergic dermatitis. No prospective cohort studies have been performed investigating the effects of Cytopoint in dogs with allergic dermatitis using the dosing protocol prescribed on the product label in the United States. In this study, our objectives were to assess the efficacy of Cytopoint for treatment of canine allergic dermatitis of variable etiologies and management of the associated pruritus, and add to the body of evidence available to the veterinarian as they make treatment recommendations. Dogs included in this study had moderate to severe pruritus according to the Pruritus Visual Analog Scale (PVAS; ≥ 50 mm) and a history of likely continuation of pruritus at the time of presentation. On day 0, investigators recorded the initial body weight and every patient received one dose of Cytopoint (minimum 2 mg/kg SQ) and an isoxazoline product for parasite control. Treatment success for this study was defined as a ≥20 mm reduction in PVAS from Day 0. On Day 7, 94% of the dogs had achieved treatment success. On Day 28, 98% had achieved treatment success and cumulatively by day 56, 100% of the dogs achieved treatment success. This prospective study provides evidence that Cytopoint effectively treats dogs with allergic dermatitis of different types and the associated pruritus.

Weekly topical therapy based on plant extracts combined with lokivetmab in canine atopic dermatitis

BACKGROUND

Lokivetmab is an effective treatment for atopic dermatitis (AD) in dogs. The aim of this prospective study was to determine if topical products containing plant extracts could enhance the clinical efficacy of lokivetmab.

ANIMALS

Thirty atopic dogs were included.

METHODS AND MATERIALS

Dogs were allocated randomly to be treated either with a single injection of lokivetmab (mean dose 1.34 mg/kg; Group A) or to a single injection (mean dose 1.28 mg/kg) coupled with a weekly topical treatment using a shampoo and a spot-on specifically designed to improve skin barrier defect (Group B). Clinical parameters evaluated included pruritus (pruritus Visual Analog Scale) and skin lesions (Canine Atopic Dermatitis Lesion Index, CADLI); cosmetic evaluation, and owner and investigator global assessment of efficacy (OGATE) also were carried out. Dogs were re-examined after 10, 17 and 31 days, and until a clinical relapse occurred.

RESULTS

An improvement was noted for all dogs, with scores being significantly better in dogs in Group B than in those in Group A; after 10 days for cosmetic evaluation, 17 days for pruritus (P = 0.039) and OGATE, and 31 days for CADLI (P = 0.043). A longer-lasting remission was noted in Group B compared to Group A; dogs receiving the combined treatment showed an extended time to flare compared to dogs treated with lokivetmab alone (P = 0.012).

CONCLUSIONS AND CLINICAL IMPORTANCE

This study suggests that combining lokivetmab with topical therapies designed to repair the skin barrier potentially have value in the treatment of AD in dogs.

Successful nutritional control of scratching and clinical signs associated with adverse food reaction: A randomized controlled COSCAD'18 adherent clinical trial in dogs in the United States

Background

Adverse reactions to food are a common dermatological condition in dogs, requiring nutritional intervention using a novel or hydrolysate protein‐based food.

Objective

To evaluate a therapeutic food containing egg and phytonutrients in dogs with food allergies using an activity monitor and core outcome set for canine atopic dermatitis (COSCAD'18) guidelines and in a controlled double‐masked, multicenter, prospective clinical trial.

Animals

Adult dogs with a history of adverse food reaction as diagnosed by a food elimination trial were recruited from general practices.

Methods

After a 21‐day baseline period, dogs were randomized to test or positive control (hydrolyzed protein) food for 21 days. Owner (pruritus visual analog score [PVAS], coat quality, food acceptance, and satisfaction) and veterinarian (canine atopic dermatitis lesion index [CADLI], physical examination) assessments were completed on days 0, 21, and 42. Dogs wore a collar‐mounted activity monitor to record scratching and shaking behavior throughout the study. Statistical analysis included within‐group comparison to baseline and between‐group comparison at study end using a significance threshold of alpha = 0.05.

Results

At the end of the treatment period, all results were similar between groups for CADLI, PVAS, owner satisfaction, activity, and questionnaire data. Scores for hair dullness, brittleness, amount of dandruff, feces quality, and food acceptance were positive and not statistically different between groups.

Conclusions and Clinical Importance

The therapeutic test food was well‐accepted and efficacious in managing signs of adverse reactions to food compared to baseline as well as compared to the positive control food.

Successful nutritional control of scratching and clinical signs associated with adverse food reaction: A randomized controlled COSCAD'18 adherent clinical trial in dogs in the United Kingdom

Background

Adverse reactions to food are a common dermatological condition in dogs, requiring nutritional intervention using novel or hydrolysate protein‐based foods.

Objective

To evaluate a therapeutic food containing egg and phytonutrients in dogs with food allergies using an activity monitor and core outcome set for canine atopic dermatitis (COSCAD'18) in a controlled double‐masked, multicenter, prospective clinical trial.

Animals

Adult dogs with a history of adverse food reaction as diagnosed by a food elimination trial were recruited from general practices.

Methods

After a 21‐day baseline period, dogs were randomized to test or positive control (hydrolyzed protein) food for 21 days. Owner (pruritus visual analog score [PVAS], coat quality, food acceptance, and satisfaction) and veterinarian (canine atopic dermatitis lesion index [CADLI], physical examination) assessments were completed on days 0, 21, and 42. Dogs wore a collar‐mounted activity monitor to record sleep, scratching, and shaking behavior throughout the study. Statistical analysis included within‐group comparison to baseline and between‐group comparison at study end using a significance threshold of alpha = 0.05.

Results

At the end of the treatment period, all results were similar between groups for CADLI, PVAS, owner satisfaction, activity, and questionnaire data. Scores for hair dullness, brittleness, amount of dandruff, feces quality, and food acceptance were positive and were not statistically different between groups.

Conclusions and Clinical Importance

The therapeutic test food was well‐accepted and efficacious in managing signs of adverse reactions to food compared to baseline as well as compared to the positive control food.

Performance of Daily Pads Containing Ophytrium and Chlorhexidine Digluconate 3% in Dogs With Local Cutaneous Bacterial and/or Malassezia Overgrowth

Local disturbances of the microbiota are common in dogs with underlying skin conditions. Antiseptic topical products are indicated to control such superficial disorders. The objective of this study was to evaluate the performance of a daily application of pads containing Ophytrium and chlorhexidine digluconate 3% (DOUXO® S3 PYO Pads, Ceva Santé Animale, France) in dogs with focal bacterial and/or Malassezia overgrowth. Eighteen dogs with focal skin dysbiosis were included in the analysis of this prospective, multicentric, field study. Dogs received daily pad applications for 14 days. Bacterial and/or Malassezia counts per microscopic field and a global score of the most affected patch (0-17 scale based on extension, severity, bacterial, and Malassezia cytological scores) were assessed by a veterinarian and pruritus by the owner (Pruritus Visual Analog Scale) on days (D)0, D7, D14. Owner and veterinarian evaluations for performance and satisfaction were recorded. Eleven dogs had primarily cocci overgrowth and seven mostly Malassezia. Mean bacterial and Malassezia counts decreased after 14 days (6.9-1.1; 7.6-1.5, respectively); 88.9% of dogs achieved a ≥70% microbial decrease and had ≤2 bacteria and ≤1 Malassezia per oil field. Mean global score of the most affected patch and pruritus score significantly improved at D14, respectively, from 8.6 to 2.6 and 4.5 to 1.2 (P < 0.05 each, mean improvements of 70.4 and 71.4%, respectively). Global veterinary assessment of the protocol was satisfactory, good, or excellent in 88.9% of cases. Most owners (94.4%) considered the protocol efficacious. Using a pad containing Ophytrium and chlorhexidine digluconate 3% daily for 14 days improved the skin condition and pruritus of dogs with local dysbiosis, resulting in high satisfaction levels for both veterinarians and dog owners.

What outcomes should be measured in feline chronic kidney disease treatment trials? Establishing a core outcome set for research

Chronic Kidney Disease (CKD) is an important cause of feline morbidity and mortality. There is currently no agreement on which outcomes are most important in CKD treatment trials to assist evidence-based decision making. Core Outcome Sets (COSs) originated in human healthcare and are an agreed set of outcomes to be measured and reported as a minimum in any trial conducted relating to a particular disease. To establish a COS for feline CKD, this study used a systematic review and two consensus methodologies (an electronic Delphi (eDelphi), and an in-person consensus meeting), with an international panel of key stakeholders. The systematic review identified 104 unique published parameters, which were rated by panellists in round 1 of the eDelphi. Panellists were also asked to suggest additional parameters. In round 2 these additional parameters were rated and any parameters not understood by >10 % of panellists in round 1 were redefined and re-rated. Parameters reaching consensus in rounds 1 and 2 were removed from round 3, when all remaining parameters were re-rated by panellists who could view their own previous rating alongside the median rating of the whole panel. To reach inclusion in the COS, parameters had to be rated 8 or 9 on a Likert scale of 1-9 (where 1 was not important and 9 was very important) by more than 80 % of panellists. In the consensus meeting, panellists discussed and re-rated borderline parameters and streamlined the final COS. Borderline parameters were those that had been closest to, but not achieved, the 80 % threshold for inclusion. The eDelphi panel (n = 73) rated 24/104 parameters highly enough for inclusion and proposed an additional 20 parameters, of which 3 reached the inclusion threshold. This totalled 27 parameters for inclusion. The consensus meeting panel (n = 16) rated an additional 6/20 borderline parameters highly enough for inclusion. During the streamlining process, 4 parameters were removed as one was considered not an outcome, and three were already addressed by other parameters. The remaining COS totalled 29 parameters. These were grouped into 9 core themes: clinical examination, quality of life, serum biochemistry, complete blood count, urinalysis, total amount of food eaten, CKD progression, survival time and cause of death. This is the first COS for feline medicine. In future treatment efficacy trials the COS will strengthen the evidence-base for this condition, by facilitating easier comparison of results between studies, and reduce research waste.

A proposed medication score for long-term trials of treatment of canine atopic dermatitis sensu lato

BACKGROUND

The use of concurrent medications is necessary in trials of treatment of canine atopic dermatitis. Our aim was to use the best available evidence to construct and then to validate a medication score (MS) formula that will estimate the impact of concurrent medications on trial outcomes.

METHODS

Trials of 15 interventions were scrutinized to find those that were consistent in terms of specific medication, administration route and dosage regimen. A MS was constructed in five steps, starting from assigning a score of 1 for each day on oral prednisone, prednisolone or methylprednisolone at 0.5-1.0 mg/kg. The MS score was validated using the clinical records of 35 dogs with atopic dermatitis that had been treated for a period of 12 ± 2 weeks with six of these medications and compared with a previously published non-validated MS.

RESULTS

A MS could be assigned to eight treatments, six of which had been administered to the 35 dogs. A positive correlation was seen with the previously published MS and a negative correlation with changes in lesional and pruritus scores.

CONCLUSION

This MS may be a useful tool in new studies evaluating the efficacy of treatments in canine atopic dermatitis.

Treatment of the feline atopic syndrome - a systematic review

BACKGROUND

Feline allergic skin disease and asthma occur regularly in small animal practice.

OBJECTIVES

To provide evidence-based recommendations for small animal practitioners on the treatment of feline atopic syndrome (FAS).

METHODS AND MATERIALS

The authors reviewed the literature available before February 2020, prepared a detailed evidence-based literature review and made recommendations based on the evaluated evidence.

RESULTS

Sixty-six papers and abstracts were identified describing treatment interventions for FAS and evaluated to establish treatment recommendations. For many treatment options, the papers were retrospective, open studies or case reports.

CONCLUSION AND CLINICAL RELEVANCE

In this review, there was good evidence for the efficacy of systemic glucocorticoids and ciclosporin, and limited evidence for the efficacy of topical glucocorticoids, oclacitinib and allergen-specific immunotherapy in feline atopic skin syndrome. Evidence pointed to low-to-moderate efficacy for antihistamines, fatty acids and palmitoyl ethanolamide. In feline asthma, there was good evidence for the efficacy of oral and inhaled glucocorticoids, and limited evidence of moderate efficacy for allergen-specific immunotherapy. Evidence supported low-to-moderate efficacy of mesenchymal stem cells, inhaled lidocaine and oclacitinib as treatments for feline asthma. For almost all therapeutic options (with the exception of glucocorticoids and ciclosporin), more randomised controlled trials are needed.

Evaluation of skin erythema severity by dermatoscopy in dogs with atopic dermatitis

BACKGROUND

To estimate the extent and severity of atopic dermatitis (AD)-related skin lesions, clinical trials enrolling dogs with AD often use categorical scales such as the Canine Atopic Dermatitis Extent and Severity Index, 4^th iteration (CADESI-04) and Canine Atopic Dermatitis Lesion Index (CADLI). Despite recent progress in the standardization of these AD-grading scales, the evaluation of the severity of skin lesions (including erythema) remains subjective.

OBJECTIVES

To validate an optical set-up with a smartphone and a dermatoscope for the objective estimation of skin erythema severity in atopic dogs.

ANIMALS

Forty-three dogs with AD.

METHODS AND MATERIALS

An erythema index (EI) was calculated from calibrated skin images and compared to the dermatologist's erythema severity estimate using the erythema grading scale used in the CADESI-04, as well as an ad hoc Visual Analog Scale (VAS) with a continuous palette of red shades.

RESULTS

We found a strong correlation based on the Spearman rank correlation coefficient between all erythema valuations: CADESI-04 and VAS: 0.93 [95% CI: (0.85, 0.96)]; CADESI-04 and EI: 0.85 (0.72, 0.92); VAS and EI: 0.82 (0.67, 0.91). There was a good agreement between the objective EI and CADESI-04-based estimates because 71% of samples were classified in the same erythema severity category. When comparing the EI and the VAS, the standard deviation of misestimates was 12% (maximum 100%).

CONCLUSIONS AND CLINICAL RELEVANCE

The proposed optical set-up has the potential to make erythema severity estimation objective, thus leading to more reliable AD severity scales for the use in experimental canine AD models or in clinical trials enrolling atopic dogs.

Clinical efficacy of spray-based heat-treated lactobacilli in canine atopic dermatitis: a preliminary, open-label, uncontrolled study

BACKGROUND

Canine atopic dermatitis (cAD) is a common inflammatory and pruritic skin disease, with various treatment options. The use of topical products containing natural ingredients has proven increasingly popular.

OBJECTIVE

To evaluate the effects of a spray solution containing heat-killed Lactobacillus rhamnosus and L. reuteri, on the clinical signs and cutaneous microbiota of atopic dogs.

ANIMALS

Ten privately owned, mildly affected, nonseasonally atopic dogs.

METHODS AND MATERIALS

The spray was applied to the ventrum every 24 h for 28 days. Clinical scores, skin barrier function and owner assessment were evaluated on day (D)0, D14, D28 and D42. The cutaneous microbiota was analysed on D0 and D28.

RESULTS

A reduction in the total clinical score was seen at each time point (D14, P = 0.03; D28, P = 0.04; D42, P = 0.001). A reduction in the regional clinical scores was seen after D28 (P = 0.01) and D42 (P = 0.003). A significant reduction in the pruritus score was seen on D42 (P = 0.01). A lower hydration value was seen on D28 (P = 0.02) and D42 (P = 0.02) on the pinnae. A good-to-excellent response and an easy-to-use administration was reported by owners. There were no significant changes in the cutaneous microbiota after 28 days.

CONCLUSIONS AND CLINICAL IMPORTANCE

There was a significant and rapid decrease in the clinical signs associated with cAD after use of the spray. Future larger, randomized, controlled studies are needed to confirm these results and to assess the effects on the cutaneous immunity and microflora of atopic dogs.

Development and validation of a graphic 2D investigator's global assessment instrument for grading the overall severity of atopic dermatitis in dogs

BACKGROUND

Clinical trials enrolling dogs with atopic dermatitis (AD) use validated instruments that aggregate the extent and severity of selected skin lesions; none of these provides a global assessment of the severity of all lesions.

OBJECTIVES

To validate an Investigator Global Assessment (IGA) instrument to globally evaluate the severity of skin lesions in dogs with AD.

ANIMALS

Forty dogs with AD.

METHODS AND MATERIALS

A 2D graphic IGA (2D-IGA) instrument was created to subjectively score, with a single dot, the overall extent and severity of all canine AD lesions. This tool was tested for its validity (content, construct and criterion), reliability (inter- and intraobserver) and sensitivity to change.

RESULTS

The content of the 2D-IGA was first validated by a supportive vote by the International Committee of Allergic Diseases of Animals (ICADA) membership. Its construct was verified by positive correlations between the 2D-IGA scores and those of the Canine Atopic Dermatitis Extent and Severity Index, 4^th iteration (CADESI-04) and the Canine Atopic Dermatitis Lesion Index (CADLI) (Spearman's rank-order correlation, P < 0.0001). The positive correlation (P < 0.0001) between an Owner Global Assessment of Disease Severity (OGADS) and the 2D-IGA indirectly satisfied its criterion. Scores graded by the same investigator hours apart and those between investigators were positively correlated (P < 0.0001), thereby validating this scale's intra- and interobserver reliabilities. Finally, the changes in 2D-IGA values during treatment were correlated positively with scores of an Owner Global Assessment of Treatment Efficacy (OGATE; P < 0.0001), thus showing its sensitivity to change.

CONCLUSIONS AND CLINICAL IMPORTANCE

This novel 2D-IGA is a simple static graphic instrument that could be useful for clinical trials testing the efficacy of interventions for canine AD.

Serum IgE and IgG responses to dietary antigens in dogs with and without cutaneous adverse food reactions

BACKGROUND

It is suspected that many canine cutaneous adverse food reactions (CAFR) are true immunological hypersensitivities; however, few specific dietary allergens have been identified.

OBJECTIVE

To compare serum immunoglobulin (Ig)E and IgG reactivity to specific food antigens in privately owned dogs with and without CAFR.

ANIMALS

Eighteen adult dogs with nonseasonal pruritus recruited from a hospital population.

METHODS AND MATERIALS

Dogs were fed an extensively hydrolysed poultry-based diet exclusively for 12 weeks. Serum was collected at the beginning of the trial. Canine atopic dermatitis extent and severity index and pruritus Visual Analog Scale scoring were performed at the beginning and end of the trial. Immunoblotting was performed to identify IgE and/or IgG binding to specific proteins in beef, egg, milk, chicken, pork, soy and wheat extracts.

RESULTS

A CAFR (defined as an unequivocal relapse of pruritus after dietary challenge) was diagnosed in 10 dogs, with 60% relapsing when fed chicken-based diets. Binding of subjects' IgG to almost all proteins in all extracts was seen regardless of reported dietary history. Few proteins were exclusively or predominantly bound by IgE in CAFR dogs. Exceptions included a 42 kDa band (chicken), a 52 kDa band (beef), a 46 kDa band (beef and milk) and a poorly defined high molecular weight protein or proteins (beef and milk).

CONCLUSION

This study demonstrated three protein bands and a poorly defined band predominantly recognized by sera from dogs with CAFR relative to non-CAFR dog sera. Almost all proteins were bound by IgG in all dogs, suggesting prior exposure to unreported foods.