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Lokivetmab therapy for pruritus in a dog with cutaneous mastocytosis

Meichner, Kristina, Kiupel, Matti, Kasantikul, Tanit, Rakich, Pauline, Banovic, Frane
Veterinary dermatology 2019 v.30 no.1 pp. 73
abdomen, antihistamines, biopsy, blood, blood chemistry, crossbreds, cyclosporine, dog diseases, dogs, exons, females, histopathology, immunohistochemistry, mast cells, monoclonal antibodies, mutation, polymerase chain reaction, prednisone, pruritus, remission, skin lesions, spaying, veterinary medicine
BACKGROUND: Cutaneous mastocytosis (CM) is a rare disease of dogs characterized by rash, pruritus and proliferation of mast cells in the skin. Oral H1 antihistamines are recommended as the treatment to control pruritus. HYPOTHESIS/OBJECTIVE: To describe the effective treatment of pruritus associated with CM with lokivetmab in one dog. ANIMAL: A 4‐year‐old, spayed female cross‐bred dog presented with severely pruritic, erythematous to pigmented macules and papules involving the ventral abdomen, interdigital skin, perivulval area and both pinnae; the pruritus had been unresponsive to treatment with antihistamines, prednisone and ciclosporin. METHODS AND MATERIALS: Complete blood count and serum biochemistry, abdominal ultrasound, blood smear and skin cytological evaluation, PCR, histopathological and immunohistochemical examination of skin biopsies. RESULTS: Skin cytological evaluation revealed high numbers of uniform, heavily granulated mast cells; histopathological findings showed focal dermal proliferations of well‐differentiated, uniform mast cells consistent with a low‐grade mast cell tumour (MCT). Clinical staging revealed that the disease was confined to the skin. Mutations of c‐kit exon 8 and 11 were not detected. Treatment was initiated with anti‐canine‐interleukin (IL)‐31 monoclonal antibody lokivetmab; antihistamines were continued. The dog's pruritus resolved within seven days and was maintained in remission over 15 months with once monthly lokivetmab injections; the skin lesions improved but did not resolve. CONCLUSION AND CLINICAL IMPORTANCE: Lokivetmab treatment was effective in resolving and maintaining pruritus remission in this dog with widespread cutaneous mast cell disease. Whether CM in dogs represent a separate entity that should be distinguished from a low‐grade MCT requires further investigation.