Efficacy of two formulations of afoxolaner (NexGard® and NexGard Spectra®) for the treatment of generalised demodicosis in dogs, in veterinary dermatology referral centers in Europe

Efficacy of an oral formulation of afoxolaner and milbemycin oxime against Tunga penetrans in naturally infected dogs

BACKGROUND

The sand flea Tunga penetrans is one of the agents of tungiasis, an important parasitic skin disease affecting humans and several mammalian species. Tungiasis is mainly observed in disadvantaged rural and peripheral urban communities in Latin America and sub-Saharan Africa. The dog is a major reservoir of Tunga fleas. Hematophagous adult female Tunga spp. embed and grow in their host's epidermis and cause cutaneous inflammatory disorders. NexGard Spectra® is an orally administered endectocide for dogs, a co-formulation of the isoxazoline afoxolaner and the macrocyclic lactone milbemycin oxime. The objective of this study was to assess the efficacy of this product against canine tungiasis.

METHODS

A blinded, negative-controlled field trial was conducted in a Brazilian community known to be highly endemic for tungiasis. Sixty-six dogs naturally infected with live T. penetrans were randomly allocated to a treated group (44 dogs) and an untreated control group (22 dogs). In a first phase, dogs from the treated group were treated on days 0, 30, and 60. Efficacy was evaluated on the basis of the macroscopic parasitic skin lesions (Fortaleza classification) on days 7, 14, 21, 30, 45, 60, 75, and 90. In a second phase, to evaluate natural reinfections, all dogs were treated on day 90 and evaluated every 2 weeks thereafter until at least 30% of dogs were infected with live sand fleas.

RESULTS

During the first phase, efficacy (reduction in live sand fleas) of 92.4% was demonstrated on day 7. From day 14 until day 90, the efficacy of NexGard Spectra® was 100%. In the second phase, all dogs were free of live T. penetrans from 15 until 45 days after the day 90 treatment; 60 days post-treatment, 11% of dogs were reinfected, and 75 days post-treatment, 40% of dogs were reinfected.

CONCLUSIONS

NexGard Spectra® was demonstrated to be highly effective against canine tungiasis. In addition to an obvious beneficial effect on the health and welfare of the treated dog, the use of this product may have a one-health benefit on human cases by controlling the main reservoir of sand fleas.

Efficacy of afoxolaner (NexGard®) against natural infestations with Trichodectes canis in dogs under field conditions

Background

Trichodectes canis is a small chewing louse found globally that primarily infests dogs. Limited information is available on the efficacy of isoxazolines against infestation with the chewing louse. In the present study, we evaluated the efficacy of afoxolaner, an isoxazoline class compound, in naturally infested domestic dogs.

Methods

The field study was carried out in Romania. Between September 2021 and December 2021, 43 dogs with confirmed T. canis infestation were included in the study. On the day of the inclusion (day 0), each animal was clinically examined and randomly treated with a control product labeled for use against lice [fipronil-(S)-methoprene combination (Frontline Combo®; Boehringer Ingelheim)] or with the investigational product [chewable tablets containing afoxolaner (NexGard®; isoxazoline)]. Each animal was evaluated for the presence of lice at 15 and 30 days post-inclusion.

Results

Of the 48 dogs initially included in the study, 43 completed the treatment period [18 in the control group (CG) and 25 in the investigational group (IG)]. At day 14, no living T. canis lice were detected on the dogs in either group. At day 14, dead lice were detected in four dogs in the IG, while eggs were present in two dogs in the IG and in one dog in the CG. At day 30, no lice were detected in either group, while eggs were still present in one dog in the CG.

Conclusion

These results suggest that afoxolaner is a feasible treatment option against chewing lice in dogs, providing 100% curative efficacy.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s13071-022-05428-y.

Efficacy of afoxolaner for the treatment of ear mite infestation under field conditions

Otodectes cynotis is a commonly occurring surface mite that can be easily transmitted between suitable hosts, including dogs, causing otocariosis. The activity of the systemic insecticide afoxolaner against O. cynotis has been tested once under experimental conditions, showing a high efficacy. The present study aimed to i) assess the efficacy of two consecutive monthly oral administrations of afoxolaner (NexGard®) against O. cynotis in naturally infested dogs under field conditions and ii) evaluate its impact in reducing bacteria or fungal secondary infections. Dogs, positive for O. cynotis (n = 20), were included in the study and allocated in two groups of ten animals each (G1, control group, and G2, treated group). The first group of ear mite-infested dogs was treated with a placebo, while afoxolaner was administered orally to the second group of dogs at Day 0 (D0) and Day 30 (D30), following label instructions. Otoscopic assessments, deep-swab method and swab samples were performed on all dogs (Days 0, 30, 42) to evaluate the presence or absence of live mites and their number throughout the study, as well as to conduct bacterial and fungal assessments. No adverse events likely related were recorded throughout the study. By Day 42 (D42), all dog's ears were flushed to recover ear mites. All treated dogs became negative, as well as two dogs of the control group. The treatment efficacy of afoxolaner was 100 % based on the arithmetic means of the live mite counts. The clinical scores did not change significantly in the control group, whereas they significantly improved in the treated one from D0 to D30 (p-value = 5.47 10^-5). No live mites were present in the afoxolaner-treated group at D42 (p-value = 0.00073). In this field study, two oral administrations of afoxolaner at the recommended dose allowed a complete cure of the infestation. Bacterial and Malassezia pachydermatis infections were detected in both groups, although no significant trend was associated to the ear mite treatment.

Efficacy of a single administration of afoxolaner (NexGard®) or fipronil plus permethrin (Frontline® Tri-Act) against Hyalomma marginatum ticks in dogs

This study was conducted to assess the acaricidal efficacy of afoxolaner (NexGard®, Boehringer Ingelheim), and fipronil - permethrin (Frontline® Tri-Act, Boehringer Ingelheim) administered once to dogs experimentally infested with Hyalomma marginatum ticks. Twenty-four Beagle dogs were randomly allocated based on a pre-treatment H. marginatum infestation to an untreated control group, a NexGard® or a Frontline® Tri-Act treated groups. Treatments were administered once on Day 0 as per the products' labels. For the efficacy evaluation, dogs were experimentally infested with 30 adult H. marginatum ticks on Days -2, 7, 28 and 36. In-situ counts were performed at 48 h post-treatment on Day 2 and post-infestations on Days 9, 30 and 38. Ticks were removed and counted at 72 h post-treatment on Day 3 and after each tick infestation on Days 10, 31 and 39. The numbers of live ticks counted in the treated groups were significantly different than in the control group at all time-points (p ≤ 0.0006). The efficacy was at least 97% after 48 h, and at least 99% after 72 h for both treatments. In this study both afoxolaner and fipronil/permethrin formulations demonstrated a high efficacy against adult H. marginatum ticks in treated dogs for at least five weeks.

Evaluation of a clinical scoring system for canine demodicosis

BACKGROUND

Canine demodicosis is a common disease in small animal practice. Although a number of studies evaluating treatment efficacy for canine demodicosis have used clinical scoring systems, none have been validated.

OBJECTIVES

This study evaluated the validity, reliability, reproducibility and sensitivity to change of a clinical scoring system for canine demodicosis.

METHODS AND MATERIALS

Fifty-eight dogs with generalised demodicosis were evaluated using a clinical scoring system that assessed erythema, comedones/ papules/pustules, follicular casts/scales/crusts and alopecia, rated from none to mild, moderate and severe in 36 body locations. Two evaluators scored lesions at monthly consecutive visits during treatment. Mites were counted to a maximum of 50 in four deep skin scrapings. With >50 mites, the approximate mite number was calculated with the help of a grid drawn onto the slide before placing the scraped material onto it.

RESULTS

A Pearson correlation coefficient showed a high interobserver reliability (r = 0.97) between two different clinicians evaluating the same dog. The Wilcoxon signed rank test showed good sensitivity to change with a reduction of clinical scores with each of the first six evaluations (P < 0.0001). A linear mixed model also showed a clear reduction in mite counts (P < 0.001) and clinical scores (P < 0.0001) from the first evaluation with time.

CONCLUSION AND CLINICAL RELEVANCE

The clinical scoring system for canine demodicosis evaluated in this study showed a good sensitivity to change and interobserver reliability, and can be used in studies evaluating canine demodicosis.

Efficacy of a novel topical combination of esafoxolaner, eprinomectin and praziquantel against ear mite (Otodectes cynotis) infestations in cats

Esafoxolaner, a purified enantiomer of afoxolaner with insecticidal and acaricidal properties, is combined with eprinomectin and praziquantel, nematodicidal and cestodicidal compounds, in NexGard® Combo, a novel topical endectoparasiticide formulation for cats. The efficacy of this formulation was assessed against Otodectes cynotis in two laboratory studies conducted in South Africa and in the USA with local isolates, and in one field trial conducted in Europe. In each study, cats were randomly allocated to a placebo-treated control group and a novel formulation-treated group. In the laboratory studies, cats were treated at the minimum recommended dose; in the field trial, cats were treated at label dose. All included cats were diagnosed positive for O. cynotis prior to treatment by otoscopy. The main variable of efficacy was a comparison of the number of live O. cynotis collected in both ear canals of all cats in the treated and control groups, one month after treatment. Efficacy of the novel topical formulation exceeded 97% in the three studies. These studies demonstrated the high effectiveness of NexGard® Combo in cats for the treatment of O. cynotis infestations. No health abnormalities were attributed to the treatment in any of the studies.

Pharmacokinetics of a novel endectoparasiticide topical formulation for cats, combining esafoxolaner, eprinomectin and praziquantel

Esafoxolaner, a purified enantiomer of afoxolaner with insecticidal and acaricidal properties, is combined with eprinomectin and praziquantel in NexGard® Combo, a novel topical endectoparasiticide formulation for cats. The parasiticide potencies of topical esafoxolaner, eprinomectin and praziquantel, are based on transcutaneous absorption, systemic distribution, and exposure of respective target parasites. For each compound, the pharmacokinetic profile, non-interference, dose linearity/proportionality after one administration, and the accumulation and time to reach a steady state after repeated monthly administrations of the novel formulation, were investigated. After one topical application of NexGard® Combo at the minimum recommended dose, the mean plasma concentration of esafoxolaner immediately reached (and remained at) a level supporting rapid onset and sustained efficacy against ectoparasites for at least 1 month. The mean Cmax, Tmax, T1/2, and the topical bioavailability of esafoxolaner were 130 ng/mL, 7.1 days, 21.7 days and 47.2%, respectively, and the plasma profiles of eprinomectin and praziquantel supported their known endoparasiticide properties. No relevant interference between the three compounds was observed. Dose proportionality was demonstrated for the three compounds over a range of 0.5× to 2× the minimum recommended dose. Steady state after repeated monthly administrations was reached by the second dose for praziquantel and by the fifth dose for esafoxolaner and eprinomectin. Accumulation was limited and drug plasma concentrations were maintained within a safe level.

Recent Advancements in the Control of Cat Fleas

Simple Summary

The cat flea Ctenocephalides felis felis is the most important pest of domesticated cats and dogs worldwide. This review covers the recent advancements in the control of cat fleas. Over the years, there has been an interest in using ecologically friendly approaches to control fleas. To date, no biological, natural, or cultural means have been discovered that mitigate flea infestations. The recent registration of novel topical and oral therapies promises a new revolution in the control of fleas and ticks and the diseases associated with them.

Abstract

With the advent of imidacloprid and fipronil spot-on treatments and the oral ingestion of lufenuron, the strategies and methods to control cat fleas dramatically changed during the last 25 years. New innovations and new chemistries have highlighted this progress. Control strategies are no longer based on the tripartite approach of treating the pet, the indoor environment, and outdoors. The ability of modern therapies to break the cat flea life cycle and prevent reproduction has allowed for the stand-alone treatments that are applied or given to the pet. In doing so, we have not only controlled the cat flea, but we have prevented or reduced the impact of many of the diseases associated with ectoparasites and endoparasites of cats and dogs. This review provides an update of newer and non-conventional approaches to control cat fleas.

Afoxolaner as a Treatment for a Novel Sarcoptes scabiei Infestation in a Juvenile Potbelly Pig

A 2 months old female Vietnamese potbellied pig presented to a veterinary teaching hospital with a referring complaint of pruritus. A human caretaker of the pig had recently been diagnosed with a Sarcoptes spp. dermatitis. Microscopic examination of the skin scrape samples and BLAST analysis confirmed the species of the mite as most closely related to Sarcoptes scabiei var. canis (AY493391). The pig was treated with afoxolaner as previous treatment with ivermectin was not efficacious. Recheck examinations and follow up revealed the pig to be non-pruritic and resolving. Afoxolaner may be a therapeutic option when treating Sarcoptes spp. infections in companion pigs.

Efficacy of combination products containing sarolaner, moxidectin and pyrantel (Simparica Trio™) or afoxolaner and milbemycin (NexGard Spectra®) against induced infestations of Ixodes holocyclus in dogs

BACKGROUND

The Australian paralysis tick, Ixodes holocyclus, causes tick paralysis in dogs and cats in the eastern coastal regions of Australia. Prevention is the best option to protect dogs against this potentially fatal disease and sarolaner provides rapid and sustained efficacy against I. holocyclus. In this laboratory study, the efficacy of two combination endectocides containing sarolaner + moxidectin + pyrantel (Simparica Trio™) and afoxolaner + milbemycin (NexGard Spectra^®) was evaluated against an artificial infestation of I. holocyclus.

METHODS

Twenty-four (n =24) foxhounds were randomly allocated to three treatment groups and artificially infested with 30 adult female viable ticks on Days - 1, 7, 14, 21, 28 and 35. On Day 0, dogs in each treatment group were treated with either Drontal^® (control group), Simparica Trio™ at the label dose to provide minimum doses of sarolaner (1.2 mg/kg), moxidectin (24 µg/kg) and pyrantel (5 mg/kg) or NexGard Spectra^® to provide minimum doses of afoxolaner (2.5 mg/kg) and milbemycin (0.5 mg/kg). Live tick counts were performed at 48 and 72 hours after treatment and after each re-infestation on Days 7, 14, 21, 28 and 35. Efficacy was determined at each time point relative to counts for control dogs based on geometric means.

RESULTS

Against an existing infestation, efficacy of both Simparica Trio™ and NexGard Spectra^® was 99.6% and 100% at 48 and 72 h time points, respectively (P = 1.000). Against subsequent weekly infestations, treatment with Simparica Trio™ and NexGard Spectra^® resulted in efficacy of ≥ 97.7% and ≥ 95.5% (P ≥ 0.0911), respectively at the 48 h time point and at the 72 h time point, Simparica Trio™ and NexGard Spectra^® resulted in efficacy of ≥ 99.0% and ≥ 98.4% (P ≥ 0.0511), respectively. There were no treatment-related adverse events in the study.

CONCLUSIONS

Single doses of Simparica Trio™ and NexGard Spectra^® were highly efficacious and provided comparable efficacy against the Australian paralysis tick, I. holocyclus for up to 35 days.

Diagnosis and treatment of demodicosis in dogs and cats: Clinical consensus guidelines of the World Association for Veterinary Dermatology

BACKGROUND

Demodicosis is a common disease in small animal veterinary practice worldwide with a variety of diagnostic and therapeutic options.

OBJECTIVES

To provide consensus recommendations on the diagnosis, prevention and treatment of demodicosis in dogs and cats.

METHODS AND MATERIALS

The authors served as a Guideline Panel (GP) and reviewed the literature available before December 2018. The GP prepared a detailed literature review and made recommendations on selected topics. A draft of the document was presented at the North American Veterinary Dermatology Forum in Maui, HI, USA (May 2018) and at the European Veterinary Dermatology Congress in Dubrovnik, Croatia (September 2018) and was made available via the World Wide Web to the member organizations of the World Association for Veterinary Dermatology for a period of three months. Comments were solicited and responses were incorporated into the final document.

CONCLUSIONS

In young dogs with generalized demodicosis, genetic and immunological factors seem to play a role in the pathogenesis and affected dogs should not be bred. In old dogs and cats, underlying immunosuppressive conditions contributing to demodicosis should be explored. Deep skin scrapings are the diagnostic gold standard for demodicosis, but trichograms and tape squeeze preparations may also be useful under certain circumstances. Amitraz, macrocyclic lactones and more recently isoxazolines have all demonstrated good efficacy in the treatment of canine demodicosis. Therapeutic selection should be guided by local drug legislation, drug availability and individual case parameters. Evidence for successful treatment of feline demodicosis is strongest for lime sulfur dips and amitraz baths.

A European field assessment of the efficacy of fluralaner (Bravecto®) chewable and spot-on formulations for treatment of dogs with generalized demodicosis

Background

Recent reports indicate that the isoxazoline compounds have the potential to provide safe and effective treatment of canine generalized demodicosis, a condition that has been traditionally difficult to cure. Controlled field studies are needed to confirm this potential. A study was therefore initiated to investigate the efficacy of a single oral or spot-on treatment with fluralaner, an isoxazoline, compared with multiple topical treatments with imidacloprid-moxidectin, in dogs naturally affected by generalized demodicosis.

Methods

Veterinary clinics in 5 European countries enrolled 134 dogs diagnosed with generalized demodicosis. Dogs were randomized to treatment with either fluralaner chewables, fluralaner spot-on, or topical imidacloprid-moxidectin in a 2:2:1 ratio. Both fluralaner formulations were administered once, at the approved dose rate, on Day 0. Imidacloprid-moxidectin was administered per label on Day 0, and every 4 weeks, more frequently if necessary. At each visit (Days 0, 28, 56, 84), dogs were monitored for demodectic mites using deep skin scrapings and observed for health and for severity of skin lesions. Treatment was considered efficacious if more than 90% of the dogs were free of live mites at both Days 56 and 84.

Results

Of 124 dogs completing the study, 57 were diagnosed with juvenile-onset demodicosis and 67 with the adult-onset form. A single treatment with oral or spot-on fluralaner was efficacious, each eliminating mites from at least 98.0% of treated dogs on Days 56 and 84. Against juvenile-onset demodicosis, efficacy of the oral and spot-on formulations was 96.0% and 100%, respectively, and against adult-onset demodicosis 100% and 96.7%. Multiple administrations of imidacloprid-moxidectin were not efficacious, eliminating mites from 87.5% of dogs (92.0% with juvenile-onset demodicosis cured; 81.8% with adult-onset demodicosis). All groups showed a marked reduction in skin lesions by Day 28, with continuing clinical improvement at each subsequent visit through Day 84. There were no treatment-related adverse events.

Conclusions

A single administration of fluralaner chewables or fluralaner spot-on is highly effective against with juvenile-onset and adult-onset forms of generalized canine demodicosis. Topically applied imidacloprid-moxidectin at weekly to monthly intervals over the 84-day study did not achieve the proportion of mite-free dogs required to demonstrate efficacy.

Immune mechanisms in human and canine demodicosis: A review

Demodex mites are saprophytic parasites of the mammalian skin, mostly found in or near pilosebaceous units of hairy regions. While they can be found in healthy humans and animals without causing any clinical manifestations, they were suggested to create pathogenic symptoms when they appear in high densities under favourable conditions (ie, demodicosis). Nevertheless, their role as the primary causative agent of the pathogenic conditions in humans is debated today. Canine demodicosis, which is highly prevalent in certain dog breeds, provides a valuable tool for studying the pathogenesis of human demodicosis. Canine and human demodicosis are caused by different Demodex species, and the clinical manifestations in former could be life-threatening. Nevertheless, current literature suggests similar immune responses and immune evasion mechanisms in human and canine demodicosis; cellular immunity appeared to have a central role in protection against demodicosis, and Demodex mites were shown to influence both innate and adaptive immune response to escape immune attack. The aim of this review is to summarize the relevant literature on demodicosis obtained from studies conducted on both organisms, and draw the attention to the effect of mite-associated factors (eg, microbiota) on the different clinical manifestations displayed during human and canine demodicosis.

Treatment of canine sarcoptic mange with afoxolaner (NexGard®) and afoxolaner plus milbemycin oxime (NexGard Spectra®) chewable tablets: efficacy under field conditions in Portugal and Germany

The efficacy of NexGard^® and NexGard Spectra^® against sarcoptic mange in dogs was evaluated in a clinical field study. Skin scrapings from dogs presenting signs suggestive of sarcoptic mange were examined to confirm infestation. A total of 106 dogs were screened at eight sites in Portugal and Germany. In all, 80 dogs that had demonstrated ≥5 live Sarcoptes mites in five skin scrapings were enrolled, scored for specific clinical signs (pruritus; papules and crusts; alopecia), and allocated at random to receive either NexGard^® or NexGard Spectra^® twice, one month apart per label instructions. To determine efficacy, live Sarcoptes mites in five skin scrapings per dog were counted, and clinical signs were scored one month and two months after first treatment and compared to pre-treatment (baseline) values. Based on compliance, 65 dogs were determined to be evaluable cases at the end of the study. The efficacy, in terms of reduction of geometric mean live Sarcoptes mite counts, was 98.9% and 99.7% for NexGard^®-treated (n = 38) and 99.6% and 100% for NexGard Spectra^®-treated dogs (n = 27) at one month and two months after treatment initiation (p < 0.001, both treatments). Both treatments resulted in a significant improvement in pruritus, papules and crusts, and alopecia one month and two months after treatment initiation (p = 0.0001, both treatments). In conclusion, this field study confirms that both NexGard^® and NexGard Spectra^® administered twice one month apart provide an effective and safe treatment against sarcoptic mange in dogs.