The present case fulfilled all the eight favrot’s criteria including history of leisonal pruritus and positive response to glucocorticoids with ruling out of other differential diagnosis, leading to the diagnosis of CAD. A test dose of Lokivetmab (0.1 ml subcutaneously) was administered and no adverse responses were observed. Following confirmation, Lokivetmab was administered monthly at 2 mg/kg SC. The administered dose of 2 mg is in agreement with
Fleck et al. (2021) who demonstrated that a single subcutaneous injection of 2 mg/kg lokivetmab produced a significant suppression of pruritus starting 3 hours post-treatment and lasting upto 42 days.
Clinical monitoring was conducted at regular intervals using the validated clinical severity scores. Pruritus were fully resolved during the therapeutic window of first 30 days. However, the pruritus and the dermatologic signs recurred after 30 days. Therefore, it was advised to administer the lokivetmab every four weeks in order to manage the clinical signs sufficiently. Hence, the lokivetmab was administered at regular intervals upon concurrence. The long term therapeutic strategy followed in the present case aligns with
Gober et al., (2025) who optimized Cytopoint treatment protocols for canine atopic dermatitis and recommended re-evaluation at 30 days, with additional doses administered as needed to achieve optimal outcomes. This long term therapy followed were in agreement with earlier pivotal studies
Gober et al. (2022);
Kasper et al., (2024), where 65 per cent of dogs showed a clinical response by Day 30 and 93 per cent of partial responders achieved treatment success after a second or third injection.
During this period, the clinical lesion scores demonstrated a progressive reduction, with the total CADESI-04 score decreasing from 91 at baseline to 59 by Day 120 and remaining stable through Day 360. The most evident clinical improvement was observed in erythema, followed by excoriation/alopecia, whereas lichenification remained unchanged after an initial decline. Visible clinical improvement was documented with resolution of erythematous lesions on the medial pinnae (Fig 2a-c), improvement of chronic papular lesions on the hind legs (Fig 3a, b) and hair regrowth above papular areas (Fig 4a, b). Complete hair regrowth was also noted at the oral commissures and elbow region by Day/ 360 (Fig 5, 6). These results indicate a sustained and steady clinical response to Lokivetmab over the 12-month treatment period (Fig 7). The reduction in lesional score are consistent with
Pinto et al., (2022) who studied the efficacy for 3 months on which they reported a reduction in CADESI-04 scores following Lokivetmab treatment, which decreased to 12 from 23.5 by Day 28 (after the second injection) and remained relatively stable at 12.5 by Day 56.
In addition, site-wise lesion scoring revealed marked improvement across most affected regions between Day 0 and Day 360. The percentage improvement in lesional scores across the evaluated anatomical sites is presented in Table 1. Hundred percent resolution of erythema, lichenification and excoriation were observed in multiple sites, including the periorbital area, medial pinnae, front paws, inguinal area and abdomen. Fifty to sixty seven per cent lesion in the hind paws and palmar metacarpals resolved. Other regions, including the axillae, flanks, perineum and ventral tail, showed no lesions at baseline and thus recorded no change. The plateau effect observed after Day 120 corresponds with
Gober et al., (2025), who documented a CADESI-04 reduction from 38.3 to 17.7 in the initial phase, with stability thereafter (17.9 at Day 180 and 18.5 at Day 365) (Fig 7).
Pruritus, measured by the PVAS, showed a gradual reduction over the treatment period. Scores decreased from 8 at baseline and remained stable until Day 30, followed by a consistent reduction to 4 from Day 60 to 150 and maintained through Day 360 (Fig 8). A PVAS score reduction by ≥50 per cent after initial treatment with lokivetmab occurred in this case is in agreement with
Kasper et al. (2024) who observed similar responses in 79 per cent of treated dogs.
Erythema Severity Score (ESS) decreased from 3 at baseline to 2 by Day 30 and remained stable until Day 210, followed by a further reduction to 1, which was maintained through Day 360 (Fig 9). These findings correlate with
Zajac et al. (2015) who reported strong associations between erythema intensity and total CADESI scores.
Dermatoscopic assessment revealed increased EIRGB scores in both lesions compared to normal skin (Fig 10). This finding is consistent with (
Cugmas and Olivry 2021), who demonstrated that smartphone-based dermatoscopy provides a convenient and reliable way to quantify erythema severity of skin erythema in dogs with AD. Such objective diagnostic tools are rapidly evolving; notably, recent advancements in deep learning and convolutional neural networks (CNN) have demonstrated high precision in lesion classification, promising reduced observer bias in future diagnostics (
Alanazi, 2025;
Cho, 2025).
The haematological parameters observed in the case were within normal physiological ranges throughout the 12-month treatment period. Hemoglobin, Packed cell volume and Red blood cell levels recorded a gradual increase, peaking at Day 180 and remained stable till day 360. White blood cells counts, including granulocytes, lymphocytes and monocytes, fluctuated slightly but does not shown any clinical significance. Platelet counts remained stable across all time points (Table 2). Biochemical parameters in this case maintained within normal physiological ranges over the 12-month treatment period. Blood urea nitrogen and creatinine levels fluctuated mildly without clinical relevance. Liver enzymes (Alanine amino transferase and Alkaline Phosphatase) showed a declining trend from baseline. Total protein and globulin levels increased at Day 180, while albumin levels remained stable (Table 3). The hematobiochemical findings were in agreement with
Krautmann et al., (2023), who reported no treatment or dose-related changes in hematology or serum chemistry following Lokivetmab administration. Similarly, the trends observed in the present case-including changes in erythrocyte mass, lymphocyte counts, serum proteins, urea, creatinine and alkaline phosphatase-were considered part of normal physiological maturation.
For the last one year, the patient is managed at the same dose of lokivetmab injections every month with home made diet and regular hypoallergenic shampoo baths every five days.
From the owner’s perspective, the long-term protocol offered practical disease management, emphasizing how easily proactive care can lapse without structured follow-up. This case also highlights the benefit of pre-scheduling monthly Lokivetmab doses to improve compliance. During the 12-month study, this case does not required any rescue treatment with systemic products like Oclacitinib (Apoquel) or oral steroids. The dog maintained pruritus levels consistently below a PVAS of 4, reflecting substantial and durable relief from CAD-associated discomfort. Furthermore, reductions in CADESI-04, PVAS and ESS scores collectively confirmed ongoing control of inflammation and lesion severity throughout the 12-month course.
