EQUINE VETERINARY EDUCATION Equine vet. Educ. (2019) 31 (8) 447-448 doi: 10.1111/eve.12901
Critically Appraised Topic What is the risk that corticosteroid treatment will cause laminitis?
E. J. Knowles Bell Equine Veterinary Clinic, Kent and The Royal Veterinary College, Hatfield, UK. Corresponding author email:
e.j.knowles@
gmail.com
Background
The association between corticosteroids and laminitis has been the subject of controversy for many years. The topic has been thoroughly appraised in two recent publications (Menzies-Gow 2015; McGowan et al. 2016). Studies published since these reviews may provide further information.
Question
In a mature horse or pony in which corticosteroids are indicated for therapeutic use, does corticosteroid treatment
TABLE 1: Relevant papers First
author, year
Welsh et al. (2017)
Patient group
7UK first-opinion practices. Data mining of 70,481 records. Effect of
triamcinolone, prednisolone, dexamethasone, methylprednisolone considered
Jordan et al. (2016)
416 horses treated with oral prednisolone (P) + 814 time matched controls (C) Ambulatory practice UK
Retrospective cohort. Review of clinical records
Laminitis a) during treatment b) over study period
Study type Outcomes
Retrospective cohort. Text mining clinical records
a) Initial episode of laminitis
b) Laminitis recurrence Key results
a) No association between corticosteroid use and initial episode
b) Prednisolone associated with laminitis recurrence. Hazard ratio 5.23 (CI 2.59–10.63)
Study weaknesses
Retrospective, record accuracy. Potential prescribing and diagnosis biases
increase the risk of developing laminitis compared with no corticosteroid treatment?
Search strategy
Literature searches were conducted for articles published in English on the Medline database (inception to April 2017), the CAB Abstracts database (1973 to January 2017) and using Google Scholar. Search terms included ‘equine’, ‘laminitis’ and ‘corticosteroid’. Recent conference proceedings were also checked. Articles were included if they reported systemic corticosteroid treatment of horses and evidence of subsequent
447
Laminitis incidence/100 horse years (95% CI)
a) during treatment: P: 20.84 (95% CI 8.35– 42.95) C: 5.66 (95% CI 1.14–16.54)
b) over study period P: 2.60 (95% CI 1.49– 4.22) C: 3.46 (95% CI 2.54–4.62) No significant differences between groups
Potter et al. (2016)
889 adult horses treated with corticosteroids 2 UK sites
Coleman et al. (2016)
199 laminitis cases. 198 healthy controls, 153 lameness controls. Multicentre, USA
Prospective cohort/ follow-up
Veterinary awareness of laminitis within 2 weeks of treatment
Laminitis in 5 (0.6%) cases. Associations between laminitis and pre-existing risk factor e.g. previous laminitis, endocrine disease
Case–control Evaluation of horse, medical and management factors in 30 days prior to onset of pasture or endocrine- associated laminitis
Corticosteroid use in previous 30 days associated with increased risk of laminitis
No control group. Potential prescribing and reporting biases
Retrospective, record accuracy. Potential prescribing + diagnosis biases. Fairly small sample (wide CIs) during treatment
Conference proceedings – detail limited but full publication expected. Recall bias?
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