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laminitis. Articles describing single cases, only intra-articular or topical corticosteroid use, ex vivo data or those that did not contain original data (i.e. expert opinion) were excluded. Articles were appraised for inclusion using guidelines established in human medicine (Centre for Evidence-Based Medicine: OCEBM-Levels-of-Evidence-Working-Group 2011; Higgins and Green 2011).
Search outcome
Many of the papers included in the recent appraisals (Menzies-Gow 2015; McGowan et al. 2016) were retrieved and are not re-appraised in this summary. The highest quality evidence retrieved was considered to be level 3 and 4 evidence. The most relevant recent papers and the strongest clinical evidence are summarised in Table 1.
Discussion
Previous appraisals concluded that there was little or no evidence to indicate a significant risk of laminitis in a healthy adult horse or pony due to corticosteroid treatment but that there was weak evidence for increased risk in animals with pre-existing risk factors (Menzies-Gow 2015; McGowan et al. 2016). Recent UK evidence supports this conclusion assuming the healthy horse has no history of previous laminitis. Numerous episodes of corticosteroid use without adverse effects are clearly documented in recent publications (Jordan et al. 2016; Potter et al. 2016; Welsh et al. 2017). However, this evidence relates to the prescribing patterns of the veterinary surgeons involved and the population treated. Other prescribing patterns, for example higher doses, longer courses or indiscriminate use may have other consequences. Data from a case–control study in the USA identified
corticosteroid use in the previous 30 days as a risk factor for laminitis. Full details of these data are not yet published and further evaluation is required. A UK-based case–control study (Wylie et al. 2013) did not find an association with recent corticosteroid use but evaluated medication use in the 7 days prior to the onset of laminitis. Population or prescribing differences could also account for these differences. Although case–control studies can highlight relative risks they cannot quantify absolute risk. In circumstances in which the baseline risk is low then a fairly large increase in risk may be of very little significance. Equally if baseline risk is high, for example in an animal with several existing risk factors then a small increase in relative risk may have significant clinical consequences. Further research is required to determine the risk profiles
for different corticosteroid preparations, doses and routes of medication and to investigate potential interactions with other risk factors.
Clinical bottom line
In most healthy adult horses, current evidence does not indicate a significant risk of laminitis with systemic
corticosteroid treatment under normal prescribing patterns at several UK practices. Some evidence indicates that corticosteroids are associated with subsequent laminitis development under some circumstances. This is likely to be most apparent in animals with an increased baseline risk, in particular those with a previous history of laminitis. In these cases a more cautious approach to prescribing may be warranted. Corticosteroids are clinically useful and the potential risks of treatment must be weighed against the welfare costs of not treating conditions for which they are indicated.
Author’s declaration of interests No conflicts of interest have been declared.
Ethical animal research Not applicable.
Source of funding None.
References
Centre for Evidence-Based Medicine: OCEBM-Levels-of-Evidence- Working-Group (2011) The Oxford Levels of Evidence 2. Available at:
http://www.cebm.net/
index.aspx?o=5653 (accessed 6 May 2017)
Coleman, M., Belknap, J., Eades, S., Fraley, B., Galantino-Homer, H., Hunt, R., Geor, R., McCue, M., McIlwraith, C.W., Moore, R., Peroni, J., Dacvs, M.S., Townsend, H., White, N., Cummings, K.J., Ivanek- Miojevic, R. and Cohen, N. (2016) Case-control study of pasture- and endocrinopathy-associated laminitis in horses. Proc. Am. Assoc. Equine Practnrs. 62, 516-517.
Higgins, J.P.T. and Green, S. (eds) (2011) Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. Available at:
http://handbook.cochrane.org (accessed 6 May 2017).
Jordan, V.J., Ireland, J.L. and Rendle, D.I. (2016) Does oral prednisolone treatment increase the incidence of acute laminitis? Equine Vet. J. 49, 19-25.
McGowan, C., Cooper, D. and Ireland, J. (2016) No evidence that therapeutic systemic corticosteroid administration is associated with laminitis in adult horses without underlying endocrine or severe systemic disease. Vet. Evid. 1, 1-14.
Menzies-Gow, N.J. (2015) I have decided to treat my RAO case with systemic corticosteroids: should I screen it for laminitis risk?. Equine Vet. Educ. 27, 332-333.
Potter, K., Barr, E. and Menzies-Gow, N.J. (2016) A prospective study to investigate the prevalence of corticosteroid-associated laminitis. Equine Vet. J. 48, Suppl. 48, 26.
Welsh, C.E., Duz, M., Parkin, T.D.H. and Marshall, J.F. (2017) Disease and pharmacologic risk factors for first and subsequent episodes of equine laminitis: a cohort study of free-text electronic medical records. Prev. Vet. Med. 136, 11-18.
Wylie, C.E., Collins, S.N., Verheyen, K.L.P. and Newton, J.R. (2013) Risk factors for equine laminitis: a case-control study conducted in veterinary-registered horses and ponies in Great Britain between 2009 and 2011. Vet. J. 198, 57-69.
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