Friday, July 20, 2007

New Treatment for Arthritis

One of the most common physical maladies faced by TREES' residents is, of course, arthritis. Some residents are afflicted as a result of overwork, some because of previous injuries, and some become arthritic as joints change during normal aging processes. More often than not discomfort can be managed through the use of joint supplements and attention to details in the horses' living quarters and turnout areas.

For some horses, however, there comes a time when symptoms of arthritis must be managed with medication. The most commonly used drug, for many years, has been phenylbutazone, or "bute." Bute is very effective, but also has well known side effects, such as damage to the gastrointestinal tract and kidneys.

During the past several weeks, it became apparent that our Grand Old Man, Jeb, a 40 year old Tennessee Walker gelding was becoming more uncomfortable. Joint supplements and management techniques alone were not controlling his arthritis pain. In cases like Jeb's, where the choice is to use bute and risk its side effects, or euthanize a horse because its pain cannot be managed, we have used bute.

As of July 5, 2007, however, we have another choice. The FDA, on that date, approved a COX-2 inhibitor sold under the brand name Equioxx, for the treatment of arthritis in horses.

An excerpt from an article in The Horse explains some of the difference between Equioxx and the older treatments:

Traditional NSAIDs such as phenylbutazone (Bute) and flunixin (Banamine), inhibit both COX-1 and COX-2. These drugs are known to cause ulcers, gastrointestinal bleeding, and kidney damage with prolonged use or high doses. COX-2-inhibiting drugs, including firocoxib and the human drugs Vioxx (rofecoxib) and Celebrex (celecoxib), selectively inhibit production of the inflammation-causing COX-2 enzyme, leaving the COX-1 enzyme free to perform its protective functions in the gastrointestinal tract and kidneys.

"On the equine market we've got the standard old NSAIDs, Bute and Banamine," said Anthony Blikslager, DVM, PhD, associate professor of equine surgery at North Carolina State University's College of Veterinary Medicine. "They're very effective for the control of pain, so they have very good efficacy. But the trouble is, they could be safer.

"I would hope that using a COX-2 inhibitor--if they can show that it's as effective as Bute--would still be safer because even though horses have overlapping function of COX-1 and COX-2, as compared to other species, you would still be leaving one of the enzymes alone to maintain organ function," Blikslager said.

Read the entire article:
New NSAID: First COX-2 Inhibitor for Horses Approved by FDAby: Erin Ryder, News Editor July 05 2007 Article # 9937

Jeb received his first dose of Equioxx yesterday. At this point, we can say that he does appear more comfortable and ate breakfast well. He is more interested in what goes on around him, and the dull look in his eye is gone. There is no predicting what the future will bring, but its good to have another weapon in the anti-arthritis-pain arsenal.

As a sidenote.........we'd like to publicly acknowledge Drs. Carrie McColgan and David Licciardello of the Rappahannock Equine Veterinary Clinic in Locust Grove, VA. TREES' elders are examined, evaluated and treated with the same thorough care and attention to detail as high-dollar show horses. We also feel that we always have their support in trying new techniques and products to further our education in geriatric horse care, and the more we learn, the more we can pass on to other elders' owners.

And so, we begin a trial of yet another new option. We'd like to hear others' experiences with Equioxx in the comments section, once you've had time to give it a fair trial.


Anonymous said...

We just gave "Rey" his first dose of Equioxx today. I am away at school and my mom says there has been no real noticeable improvement as of 12 hours after the first dosage. Usually, bute has him perked up more than this. I am also wondering what to do after his 14 days are over, if this drug does kick in and start to work. Rey has chronic laminitis but some event (we think a pretty bad outbreak of thrush) has him feeling worse than usual. He has been getting a maintenance dose of 1/2 gram of bute twice daily, but when he came up pretty lame even on this dose, the vet suggested Equioxx. I guess this all has me wondering what to expect next medication wise. Is it normal for a horse to not show improvement until a day or more later on this?

equineelders said...

When we first tried Equioxx, our vet told us it could take 2-3 days to see noticeable results. She was right on target. We saw a small difference about 24 hours after the first dose, but the real results became apparent 24 hours after the second dose.

Yout question regarding what to do following the 14 day course of treatment is one we have as well. In Jeb's case, 10 days of Equioxx got him through a period when his arthitis bothered him more than usual, but since then he has been doing well without it. Because he was able to come off the Equioxx in a short time, we have not had reason to try it long term. And truthfully, because of its cost, I'm not sure Equioxx would be a viable option for most people as a long term pain management tool, even though it seems to be effective.

I'm more than a little baffled at the marketing of this medication. It is often advertised as a treatment for arthritis and much hullabaloo is made over its "safety" compared to bute or other NSAIDS. Yet it is still recommended as a short term treatment. How is that going to help arthritis patients, whose condition is not going to "go away" in two weeks?

If you would, please keep us posted of your experiences and opinions of this treatment.

Anonymous said...

This morning Rey was down and much worse when my mom went out. I came home and asked the vet to put him back on his bute. After a re-evaluation, it looks like he has had a reoccurrence of laminitis. My vet wants to watch him for around 24 hours. I was not comfortable leaving him on the new med because I did not know for sure that it would be effective, and I know that Bute is for him. He has been down most all of today and will only get up to go to the bathroom or reposition. He has a very good appetite though and is bright eyed now after about 12 hours back on bute. This morning and the better part of the afternoon he was laboring to breathe some of the time and would just lay with his head and neck flat out. This really does not look good to me, I hate to see him like this, but I guess my vet is just being cautious and wants to make sure he is feeling the full effects of the meds before we have to make a decision. Guess I won't have much meaningful info on the new med after all, but I think, as well as you, that it has a pretty big flaw in the world of arthritis if it is not tolerable long term. Thanks for your answer.