Equine pituitary pars intermedia dysfunction: Identifying research priorities for diagnosis, treatment and prognosis through a priority setting partnership

Abstract

Pituitary pars intermedia dysfunction (PPID) is the most prevalent endocrine disorder of older equids. To date, key research areas likely to have the greatest impact on equine health have not been identified. In human medicine, public and patient involvement is widely used to inform research agendas. This study aimed to engage with veterinary surgeons and horse owners to identify evidence gaps (‘uncertainties’) and prioritise these into a list of the 10 most important PPID research questions. The James Lind Alliance (JLA) Priority Setting Partnership (PSP) Framework was adapted. Questions about the diagnosis, treatment and prognosis of PPID were gathered via an online survey targeting veterinary surgeons and horse owners with experience of PPID. Thematic analysis was used to form a longlist of collated indicative research questions (CIRQs), defined by the JLA as true ‘evidence uncertainties’ when not answered by a published, clinically relevant, up-to-date systematic review. In an interim prioritisation survey, questions were ranked by weighted scores creating a shortlist of 25 that were taken forward to the PSP workshop, where participants reached a consensus on the top 10. Useable responses containing ≥1 question were received from 524 respondents (92.6% owners, n = 485; 7.4% veterinary surgeons, n = 39). After screening for relevance, 1,260 individual questions were included in thematic analysis, resulting in 47 CIRQs. Interim prioritisation votes for the CIRQs were received from 360 respondents. The top 10 questions prioritised at the PSP workshop focused on long-term prognosis, diagnostic accuracy, efficacy of pergolide treatment, alternative treatment/management strategies and potential treatment options for poor responders to pergolide. The quantity of questions generated indicates an extensive number of uncertainties regarding the diagnosis, treatment and prognosis of PPID. The top 10 research questions will help to inform key areas for evidence synthesis and knowledge translation, and to direct future research into areas most important to end users involved in caring for and treating animals with PPID.

Pituitary Pars Intermedia Dysfunction (PPID) in Horses

“…There is little evidence regarding the long-term efficacy of Pergolide for improving prognosis [ 145 ]. However, pergolide use was associated with increased short-term survival in a recent retrospective study [ 47 ], and also a reduction in clinical signs in 40–100% of cases in a recent systematic review [ 118 ].…”

“…Research investigating the relationship between laminitis and PPID with and without hyperinsulinemia is warranted, as the relationship is still incompletely understood. A study investigating research priorities found that owners were concerned about management strategies (feed and turnout) for horses with PPID, and the response of PPID horses with laminitis to treatment with pergolide [ 145 ]. Investigating diagnostic accuracy of testing procedures in horses with subtle clinical signs may result in earlier diagnosis and initiation of treatment which could also improve survival [ 47 ].…”

Priorities for Research into the Impact of Canine Surgical Sterilisation Programmes for Free-Roaming Dogs: An International Priority Setting Partnership

“…Participants were recruited via email and social media using convenience, purposive and snowball sampling The PSP was managed by a research team (AC, JS and MLB) at the Centre for Evidencebased Veterinary Medicine (CEVM), with guidance from a steering group. The process was supported and guided by RSD who has previous experience of conducting adapted PSPs in the field of veterinary science [14,15]. The steering group comprised people with varied experiences of working with FRDs from different geographical and institutional settings, including programme managers of DPM interventions, researchers with experience in FRDs and the Director of an international dog welfare charity.…”

“…The JLA approach involves a stepwise process of establishing a group of representatives from the population of interest to identify and prioritise research uncertainties [ 10 ]. The JLA framework has only recently been adapted for use in a veterinary setting, where it has been used to set priorities for research into the treatment of feline chronic kidney disease [ 14 ] and equine pituitary pars intermedia dysfunction [ 15 ]. However, to date such priority setting has not been applied to a veterinary population management intervention.…”