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TABLE 1: Relevant papers First author, year Patient group Anon (2011)
Study type
122 PPID cases. Multicentre pergolide trial in USA
Prospective, open, clinical trial
Outcomes
Clinical signs + ACTH or DST at day 90 and 180
Key results
10 cases of laminitis (8% in 6 m). 3 new, 7 cases with previous laminitis. Overall 6 m incidence = 23% of those with prior laminitis, 3% in others.
No change in the proportion of cases with musculoskeletal pathology.
Perkins et al. (2002)
42 cases treated for PPID with ≥2 follow-up ACTH samples. Recruited via Cornell diagnostic laboratory USA
Nonrandomised cohort/follow-up study
Clinical signs and ACTH at follow-up
Laminitis improved in 17/18 (94%) cyproheptadine treated horses and 6/ 8 (75%) pergolide treated horses.
Study weaknesses
Laminitis not analysed as a clinical sign (analysed as adverse event). No control group or alternative treatment group. Concurrent treatment not reported.
Retrospective analysis. Open. Subjective recall of improvement by RVS.
Variable follow-up. Concurrent treatments not recorded. Allocation bias risk.
Donaldson et al. (2002)
27 cases treated for PPID by ambulatory service or hospital. Univ. Pennsylvania. USA
Nonrandomised cohort/follow-up study
Clinical signs, ACTH, Insulin, Glucose at follow-up
Pergolide group 16/20 (80%) had laminitis before treatment, 3/ 20 (15%) after. Cyproheptadine group 4/7 (57%) had laminitis before treatment, 4/7 (57%) after. ACTH reduced following pergolide.
Spelta and Axon (2012)
11 cases with available follow- up. 7/11 received pergolide 4/11 husbandry only Townsville, Australia
Peters et al. (1995)
9 PPID cases treated with pergolide. Kalispell, USA
Case series
Descriptive reports of clinical outcomes
4/7 Pergolide cases had laminitis at presentation. Laminitis consistently stable in 1/4 during follow-up. Mixed response in 3/ 4.
Case series
Descriptive reports of clinical outcomes
Marked improvement in 2 of 3 chronic laminitis cases.
Retrospective analysis. Open (+stated investigator perception of ↑ efficacy of pergolide). Concurrent treatment not recorded. Variable follow-up. Allocation bias risk.
Descriptive study, variable follow-up, limited detail.
Descriptive study, variable follow-up limited detail, owner reports of laminitis outcome.
PPID, pituitary pars intermedia dysfunction; ACTH, adrenocorticotropic hormone; DST, dexamethasone suppression test.
Author’s declaration of interests No conflicts of interest have been declared.
Ethical animal research Not applicable.
Source of funding None.
References
Anon (2011) Freedom of Information Summary-Original New Animal Application NADA 141-331. Available at:
http://www.fda.gov/d ownloads/AnimalVeterinary/Products/ApprovedAnimalDrugProduc ts/FOIADrugSummaries/UCM280354.pdf (accessed 9 May 2017).
Donaldson, M.T., LaMonte, B.H., Morresey, P., Smith, G. and Beech, J. (2002) Treatment with pergolide or cyproheptadine of pituitary pars intermedia dysfunction (equine Cushing’s disease). J. Vet. Intern. Med. 16, 742-746.
Higgins, J.P.T. and Green, S. (2011) Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. Available at:
http://handbook.cochrane.org (accessed 9 May 2017).
McGowan, C.M. and Neiger, R. (2003) Efficacy of trilostane for the treatment of equine Cushing’s syndrome. Equine Vet. J. 35, 414-418.
McGowan, T.W., Pinchbeck, G.P. and McGowan, C.M. (2013) Prevalence, risk factors and clinical signs predictive for equine pituitary pars intermedia dysfunction in aged horses. Equine Vet. J. 45, 74-79.
OCEBM-Levels-of-Evidence-Working-Group (2011) The Oxford Levels of Evidence 2. Available at:
http://www.cebm.net/
index.aspx? o = 5653 (accessed 9 May 2017).
Perkins, G.A., Lamb, S., Erb, H.N., Schanbacher, B., Nydam, D.V. and Divers, T.J. (2002) Plasma adrenocorticotropin (ACTH)
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