Does oral prednisolone treatment increase the incidence of acute laminitis?
Authors: Jordan V J, Ireland J L, Rendle D I
Journal: Equine veterinary journal
Summary
# Does Oral Prednisolone Treatment Increase the Incidence of Acute Laminitis? Despite widespread clinical acceptance that glucocorticoids precipitate laminitis, robust epidemiological evidence supporting this assumption has been lacking. Jordan and colleagues conducted a retrospective case-control study of 416 horses receiving oral prednisolone and 814 matched controls registered with Liphook Equine Hospital between 2001 and 2014, comparing laminitis incidence rates between groups using Cox regression analysis to identify associated risk factors. Contrary to conventional practice wisdom, the prednisolone-treated group showed no statistically significant increase in laminitis incidence (2.60 versus 3.46 cases per 100 horse-years; P = 0.8), with only 3.8% of treated horses developing laminitis compared to 5.7% of controls—and notably, fewer euthanasias in the prednisolone group. Equine metabolic syndrome and advancing age emerged as the principal risk factors for laminitis rather than prednisolone administration itself, suggesting that pre-existing metabolic status may be more clinically relevant than glucocorticoid exposure alone. These findings challenge practitioners to reconsider prednisolone as an absolute contraindication in laminitis-prone horses and to focus preventative strategies on identifying and managing underlying metabolic dysfunction, though individual patient factors and clinical context should continue to guide therapeutic decisions.
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Practical Takeaways
- •Oral prednisolone treatment does not increase laminitis risk in horses—this common concern among practitioners is not supported by this evidence
- •Metabolic syndrome and age are more important risk factors to monitor than glucocorticoid use when assessing laminitis risk
- •Practitioners can use prednisolone when clinically indicated without fear of precipitating laminitis as a direct consequence of the drug
Key Findings
- •Of 416 horses treated with oral prednisolone, 3.8% developed laminitis compared to 5.7% in 814 control horses (P = 0.8, not significant)
- •Overall laminitis incidence was 2.60 cases per 100 horse-years in prednisolone group versus 3.46 per 100 horse-years in controls
- •Only 1.7% of treated horses developed laminitis during the course of prednisolone treatment
- •Equine metabolic syndrome and increasing age were significant risk factors for laminitis, but prednisolone treatment was not