Proportion of nonsteroidal anti‐inflammatory drug prescription in equine practice

Duz, Marco; Marshall, John F.; Parkin, T. D. H.

doi:10.1111/evj.12997

Cited by 27 publications

(56 citation statements)

References 21 publications

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“…Phenylbutazone has been the mainstay of laminitis analgesia for laminitic patients for many years and continues to be used widely. Flunixin, firocoxib and meloxicam are other readily available options (Duz et al 2019).…”

Section: Anti-inflammatories and Paracetamolmentioning

confidence: 99%

A review of recent developments in the pharmacological prevention and treatment of endocrinopathic laminitis

Laat

Sillence

2020

Anim. Prod. Sci.

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Despite the prevalence of endocrinopathic laminitis, the pharmacologic options for preventing and treating the disease are severely limited. The present review aims to discuss the spectrum of potential therapeutic agents for the condition, ranging from early experimental compounds to agents nearing registration. There are different pharmacologic targets for, and approaches to, managing laminitis. Reducing hyperinsulinaemia is central to diminishing endocrinopathic laminitis risk, and a detailed understanding of the pathophysiology of insulin dysregulation is necessary to identify pathways that can be targeted to minimise post-prandial insulin secretion and action. This area of research is advancing rapidly, with several exciting prospects, such as sodium-dependent glucose co-transporter-2 inhibitors, on the horizon for the treatment of equine metabolic dysfunction. Drugs that directly target the lamellae and aim to reduce the damage inflicted on the lamellae as part of this condition, are not yet available. Although progress in this area of laminitis therapy is slower, improved understanding of the events that lead to lamellar failure has enabled the investigation of novel drugs that aim to prevent laminitis at the site of the lesion. Finally, a brief review is included of the directions being taken in the management of the chronic and acute pain that accompanies laminitis. Medications for relieving the pain associated with laminitis are currently the most-prescribed drugs for the disease, and range from simple, affordable and thoroughly tested options, such as phenylbutazone, to newer, less-understood applications such as paracetamol and gabapentin. In the future, endocrinopathic laminitis management plans will likely take a multi-faceted approach that still hinge on effective dietary management and exercise, but also include drugs that address foot pathology, pain and underlying endocrine disturbances.

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Section: Anti-inflammatories and Paracetamolmentioning

confidence: 99%

A review of recent developments in the pharmacological prevention and treatment of endocrinopathic laminitis

Laat

Sillence

2020

Anim. Prod. Sci.

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“…Non‐steroidal anti‐inflammatory drugs (NSAID) have long been used for treatment of inflammation, fever and pain. Phenylbutazone, a non‐selective inhibitor of cyclo‐oxygenase (cyclo‐oxygenase‐1, COX‐1; and cyclo‐oxygenase 2, COX‐2), is the most commonly prescribed NSAID for equine orthopaedic pain in the US 1 . Adverse effects of non‐selective COX inhibitors (such as phenylbutazone) in horses include renal medullary necrosis and ulceration of the gastrointestinal tract, primarily the glandular gastric mucosa and right dorsal colon 2‐9 …”

Section: Introductionmentioning

confidence: 99%

Impact of concurrent treatment with omeprazole on phenylbutazone‐induced equine gastric ulcer syndrome (EGUS)

Ricord

Andrews

Yñiguez

et al. 2020

Equine Veterinary Journal

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Background Phenylbutazone is commonly prescribed for treatment of various painful or inflammatory disorders in horses, but is associated with gastrointestinal (GI) adverse effects. Anecdotally, many practitioners prescribe omeprazole concurrently with phenylbutazone to reduce development of equine gastric ulcer syndrome (EGUS), but the efficacy and safety of this practice remains unknown. Objectives To evaluate the effect of omeprazole on phenylbutazone‐induced equine glandular gastric disease (EGGD) and equine squamous gastric disease (ESGD). Study design Randomised block experimental design. Methods Twenty‐two horses with EGGD and ESGD scores ≤2 were included. Horses were assigned to treatment groups: phenylbutazone (4.4 mg/kg PO q 12 h; PBZ), phenylbutazone plus omeprazole (4 mg/kg PO q. 24 h; PBZ/OME) or placebo (CON) in a randomised block design based upon initial EGGD score. Horses were treated for up to 14 days. Gastroscopy was performed weekly; CBC and biochemistry were performed at Day 0 and study end. Horses were monitored for signs of colic and/or diarrhoea. Results EGGD score increased in PBZ (median change 1, inter‐quartile range, [IQR], 0‐2) compared to PBZ/OME (median change 0, IQR −1 to 0; P = .05). PBZ/OME (6/8) had more intestinal complications than CON (0/6; difference between proportions = 75%; 95% CI, 23%‐93%; P = .03). Plasma protein concentrations decreased in PBZ, compared to CON (mean difference between groups, 14 g/L; 95% CI, 1.04‐27; P = .03). Five horses were withdrawn from the study due to intestinal complications (n = 3 PBZ/OME and n = 2 PBZ); one horse (PBZ) was withdrawn due to severe grade 4 EGGD. Main limitations Small sample size and changes in management for the 2‐3 days prior to study initiation; variable treatment duration among groups due to development of complications. Conclusions Administration of omeprazole ameliorated PBZ‐induced EGGD, but was associated with an increase in intestinal complications. Caution should be exercised when co‐prescribing NSAIDs and omeprazole in horses, particularly in association with change in management.

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“…summarised NSAID use in managing colic in a review and survey of equine veterinarians (Duz ; Duz et al . ). NSAID therapy has become a mainstay for almost all veterinarians managing horses with colic, both for management of pain and inflammation, and to aid in clinical decision‐making.…”

Section: A History Of Nsaids In Managing Colicmentioning

confidence: 97%

Sparing the gut: COX‐2 inhibitors herald a new era for treatment of horses with surgical colic

Ziegler

Blikslager

2019

Equine Veterinary Education

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Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to manage a wide variety of conditions in horses, including management of colic. Flunixin meglumine is by far the most commonly used drug in the control of colic pain and inflammation and has become a go-to for not only veterinarians but also horse-owners and nonmedical equine professionals. NSAID use, however, has always been controversial in critical cases due to a high risk of adverse effects associated with their potent cyclo-oxygenase (COX) inhibition. There are two important COX isoenzymes: COX-1 is generally beneficial for normal renal and gastrointestinal functions and COX-2 is associated with the pain and inflammation of disease. Newer selective NSAIDs can target COX-2-driven pathology while sparing important COX-1driven physiology, which is of critical importance in horses with severe gastrointestinal disease. Emerging research suggests that firocoxib, a COX-2-selective NSAID labelled for use in horses, may be preferable for use in colic cases in spite of the decades-long dogma that flunixin saves lives. The challenge of better understanding the complex inflammatory signalling cascades in endotoxaemic horses is further complicated by the dynamic and fleeting existence of individual mediators. While initial attempts were made to measure LPS in the blood as a biomarker of endotoxaemia to

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Proportion of nonsteroidal anti‐inflammatory drug prescription in equine practice

Cited by 27 publications

References 21 publications

A review of recent developments in the pharmacological prevention and treatment of endocrinopathic laminitis

A review of recent developments in the pharmacological prevention and treatment of endocrinopathic laminitis

Impact of concurrent treatment with omeprazole on phenylbutazone‐induced equine gastric ulcer syndrome (EGUS)

Sparing the gut: COX‐2 inhibitors herald a new era for treatment of horses with surgical colic

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