Effect of phenylbutazone on insulin secretion in horses with insulin dysregulation.
Authors: Kemp Kate L, Skinner Jazmine E, Bertin François-René
Journal: Journal of veterinary internal medicine
Summary
# Editorial Summary: Phenylbutazone and Insulin Dysregulation in Horses Phenylbutazone is routinely used to manage laminitis pain in horses with insulin dysregulation, yet evidence from human medicine suggests NSAIDs may paradoxically worsen insulin secretion—raising questions about whether this analgesic approach inadvertently exacerbates the underlying metabolic problem. Kemp and colleagues conducted a randomised crossover trial in 16 horses (7 with insulin dysregulation, 9 controls), administering either 9 days of phenylbutazone (4.4 mg/kg IV daily) or saline placebo before performing oral glucose tolerance tests; a 10-day washout separated treatment phases. Contrary to the hypothesis that phenylbutazone would increase insulin secretion, horses with insulin dysregulation showed significantly reduced glucose and insulin responses to the glucose challenge when treated with the NSAID, with insulin area under the curve declining from 22,930 to 17,710 μIU/mL × min (P = .03), whilst no effect was observed in metabolically normal controls. These findings suggest phenylbutazone may offer benefits beyond analgesia in managing hyperinsulinaemia-associated laminitis, potentially improving the metabolic profile of affected horses—a promising avenue warranting larger clinical trials to determine whether this drug could become part of a multimodal management strategy for insulin dysregulation rather than simply masking pain symptoms.
Read the full abstract on PubMed
Practical Takeaways
- •Phenylbutazone may have therapeutic benefits beyond pain relief in managing hyperinsulinemia-associated laminitis by reducing insulin secretion
- •The drug's effect on glucose and insulin regulation appears specific to horses with insulin dysregulation, not healthy controls
- •Further investigation is warranted to establish optimal dosing and protocols for metabolic management of laminitis-prone horses
Key Findings
- •Phenylbutazone significantly decreased glucose concentration in horses with insulin dysregulation (P = 0.02)
- •Insulin area under the curve was reduced by 23% with phenylbutazone treatment (17,710 vs 22,930 μIU/mL × min, P = 0.03)
- •Glucose area under the curve decreased from 2,847 to 2,429 mmol/L × min with phenylbutazone (P = 0.02)
- •No significant effects were observed in control horses, indicating effect is specific to insulin dysregulation