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View Full Version : Fact or Fiction? Do monthly IM Adequan injections



grayarabpony
Feb. 6, 2008, 02:07 PM
really do any good? What has the literature shown overall? I was just over at horseadvice.com and the vet who runs the site claims that clinical studies have shown that monthly IM Adequan injections are basically useless. I have a biology degree but I have no desire to wade through all of the literature. Anyone here in the veterinary field or who has had an in-depth discussion with their vet care to chime in?

Thank you.

Diamondindykin
Feb. 6, 2008, 02:19 PM
My reining gelding is on monthly Adequan injections for mild arthritis. My vet told me that I am better off using Adequan rather than supplements because there are studies that prove that Adequan works where as there are very few studies proving that supplements work. My gelding was only mildly stiff when putting him on Adequan and he now has no stiffness.......for my gelding, I would say that it works.

lizathenag
Feb. 6, 2008, 02:23 PM
When I took my current OTTB off the track at age 6, I started him on Adequan (because I could afford it and my vet said it wouldn't hurt).

since then 6 years have passed and I stopped giving it to him as I was injured and we sort of forgot. . .

but he has been in training and I have been in training and correct gymnastic riding (I mean dressage) and 24 turnout has done the trick.

any unevenness is gone. we thought it would always be there.

ytr45
Feb. 6, 2008, 02:32 PM
Your post didn't ask for personal experiences, but this topic is near-and-dear to me, so I'll just share the following. I put my older gelding with stiffness/arthritis on monthly adequan (after 4 weeks of the loading dose). I never could feel a difference in him and my dressage instructor eventually told me that she didn't want to have lessons with him anymore. He was just too stiff/resistant. I was crushed, especially after having spent all the money on monthly adequan and the loading doses. (I posted about this on the dressage forum a while ago and everyone basically said that its not fair to try to make an older arthritic horse do dressage...)

In desperation and with very little hope, I tried oral supplements for the very first time. I tried the two "big guns" together: cosequin ASU + Cetyl M. The difference is *UNBELIEVABLE* !!! I now have a soft supple horse. Even my instructor said "You have a new horse".

I know the studies say that oral supplements aren't absorbed or whatever, and that its a waste of money, so I don't know why I have a dramatic improvement. ?

grayarabpony
Feb. 6, 2008, 02:45 PM
I thought that one of the oral supplements had some special sort of formulation that is patented so that the ingredients will be absorbed -- can someone chime in on this?

BuddyRoo
Feb. 6, 2008, 02:55 PM
Cosequin has a patented technique where they're creating a molecule that actually is small enough to pass through membranes--whereas most preparations of glucosamine are simply too large (molecularly) to do that.

Regarding Adequan...not sure how much info you're looking for....but when it comes to efficacy, Cosequin Adequan and Legend all have independent empirical data supporting efficacy.

On a personal note, I used Adequan w/ my geriatric arthritic horse and it was terrific.

grayarabpony
Feb. 6, 2008, 03:22 PM
I want to know how many studies, the number of subjects in studies, and what percentage of horses improved.... that may be too much to ask, I know. I'm just confused by what I read over on horseadvice.

atr
Feb. 6, 2008, 04:14 PM
Look at the Adequan web site--I think you will find a link to the independent research there.

marta
Feb. 6, 2008, 04:16 PM
adequan clearly works and the more often the better in my experience;)
however, right now my mare is on adequan and legend and i alternate the shots every two weeks, so one week she gets adequan, then two weeks later, legend, then two weeks later adequan. so that's a monthly adequan and monthly legend. i definitely see the difference, she feels good, looks sound. i give her an extra shot of legend before competition. it runs me no more than oral supps (she was on recovery eq which i thought worked well until i tried adequan) and i get better results.

edited to say that if someone thinks i'm wasting my $ on this regiment, please let me know!

grayarabpony
Feb. 6, 2008, 06:25 PM
I found an adequancanine site, but that's it.

RAyers
Feb. 6, 2008, 06:32 PM
I went to grad school with the vets who tested Adequan (Kawcek et al). Adequan is made by Luitpold so look at thier web site. However those studies are small and geared to FDA approval. Larger studies have been done subsequently e.g Kristiansen and Kold or Todhunter et al. both used over 100 horses. They all show good effect.

Reed

Tuff Tilly
Feb. 6, 2008, 08:21 PM
One of the vets at one of the practises I use told me a story about an experiment he preformed on his personal mare. She had a plethora of joint issues, very turned in in the front, and quite turned out in the back. At the age of 6 she developed arthritic changes in her knees and hocks. He took radiographs and started her on Adequan, did a loading dose and did monthly shot thereafter. Every 3 months he took new radiographs to compare and he said you could SEE her joints improving. She's now into her twenties and he still radiographs her knees every 6 months. Says they look BETTER than they did as a 6 year old. He says Adequan is the ONLY joint injection therapy he recommends because he has SEEN it work. That being said he also says he will never push an owner to do injections because he knows the cost of it and probably wouldn't have done it at all if he wasn't a vet with access to radiographs and medications at cost. ;)

deltawave
Feb. 6, 2008, 08:23 PM
Cosequin has a patented technique where they're creating a molecule that actually is small enough to pass through membranes--whereas most preparations of glucosamine are simply too large (molecularly) to do that.

Umm, glucosamine is pretty much glucosamine. It's very small and permeates membranes very readily. Do you mean chondroitin sulfate? Their very own "trials" (I use the term loosely) show oral bioavailability for both molecules to be VERY LOW for horses. What the relevance is of their "special" chondroitin molecule, I have no idea. But patents on products like this don't mean very much in the wide world of research.

LookinSouth
Feb. 6, 2008, 09:03 PM
really do any good? What has the literature shown overall? I was just over at horseadvice.com and the vet who runs the site claims that clinical studies have shown that monthly IM Adequan injections are basically useless. I have a biology degree but I have no desire to wade through all of the literature. Anyone here in the veterinary field or who has had an in-depth discussion with their vet care to chime in?

Thank you.


I think that if you just start the monthly injections WITHOUT doing the 7 shot loading dose first you may very well be wasting your money. That said, if you start off with the loading dose and then continue with a dose AS NEEDED (which is often only once a month for many horses) you will probably see improvement. Adequan is proven to repair joints. According to my vet studies exist that prove that the drug effectively helps to rebuild cartilage in the joints. She adamantly suggests Adequan for joints vs. a oral supplement, especially in terms of preventative care.

The only time it is not as effective according to her is when the cartilage in the joints is not the issue for an older horse but a lack of joint fluid is the cause for pain etc... In such cases Legend or HA is more effective. However, I dont' believe Legend has any studies available that prove any longterm effects as far as joint repair. Legend is a more short term drug.

I personally plan to switch my horse over to Adequan this spring for his joint supplement. It is cheaper than a regular joint supplement and it acts like a preventative for horses that dont' have any real issues as far as arthritis at this time.

TheOrangeOne
Feb. 6, 2008, 09:54 PM
When I vetted my horse, he showed changes in his front fetlocks that concerned the vet. I bought him anyways, started him on the adequan and used the loading dose. When he went in later on an unrelated visit, one of the more pessimistic vets in the state (VA peeps know who!) said the joints looked fine, couple changes but nothing that concerned him. I'm sold.

Appassionato
Feb. 6, 2008, 10:04 PM
I switched from Corta-Flx w/ HA to Adequan about a year ago (per my founder vet), and have really noticed improvement! When Bo was diagnosed in December with a joint trying to fuse, going to a shot once a week for about 6 weeks helped with soundness issues. I haven't re-xrayed the joint yet, but the vet mentioned that Adequan sometimes helps with joint fusion for joints already in the process of fusing (I think from his experience). In any case, my horse felt better and that was all that mattered to me. I still need to get the joint re-x-rayed though. ;)

ButterflyIris
Feb. 6, 2008, 10:11 PM
Anyone who has had positive results....
How soon after you started the loading dose did you notice a change?
I'm on shot 4 of the 7 per month loading dose and haven't noticed a major difference yet.
thanks!!

Appassionato
Feb. 6, 2008, 10:24 PM
Me?

Remember that my guy has some pretty serious issues, but to answer I noticed some changes during the loading dose. By month 3 he felt much better!

LoriO
Feb. 6, 2008, 11:55 PM
Anyone who has had positive results....
How soon after you started the loading dose did you notice a change?
I'm on shot 4 of the 7 per month loading dose and haven't noticed a major difference yet.
thanks!!

with my mare, I didn't see any major change until the 6th injection. After the 7th the difference was incredible!

For years, I was able to keep my arthritic mare comfortable with just supplements (Hylasport by Horsetech). Last year we originally though Lizzy had hurt her back and let her have some time off to heal. When it didn't get better I had the chiroprachter out to look at her and said it was her hocks causing the back problems. The arthritis had worsned past the point that the supplements alone worked.

Started the Adequan and after the loading dose period it was amazing the difference.

c_expresso
Feb. 7, 2008, 07:43 AM
My horse gets cosqeuin as a daily supplement and Polyglycan IV injections. Adequan and Legend work really well, but Polyglycan is both of those combined into one, and it is SO much cheaper. My vet recommended it to me, and it really helped me 14 yr old eventer.

Catalina
Feb. 7, 2008, 10:42 AM
I think that if you just start the monthly injections WITHOUT doing the 7 shot loading dose first you may very well be wasting your money.

That wasn't true for my guy :). I had his hocks and stifles injected in the spring and then gave him Adequan every four weeks, but I never did the loading dose (since his hocks and stifles were injected). I could always tell when he was due for his shot because he would start to get slightly off. Two days after his Adequan, he was awesome. I am a true believer in Adequan.

grayarabpony
Feb. 7, 2008, 12:32 PM
What precisely have scientific studies shown? That the horse has pain relief? that it helps with joint fusion? that it helps slow down degeneration of the joint? that it actually helps heal the joint?

Tiligsmom
Feb. 7, 2008, 12:44 PM
Do you give the Adequan IM or IV?

purplnurpl
Feb. 7, 2008, 12:50 PM
Adequan is not supposed to make your horse feel better.
It keeps joints from further deterioration.

So anyone who is only giving adequan and says, "After the 1st month my horse was totally different!!"
Placebo effect. Sorry to break the news.

Joint injections directly into the joint are what makes them feel better.

I was told by an FEI vet that if your horse is showing no need for injections then you really don't need to do the loading dose. He had two daughters both with FEI horses and whether they showd issues or not all the horses received Adequan and Legend.

Cytel M is probably what made that one posters horsie better. Not the Cosequin. Cytel M is so completely different from the others.

I have a friend with a 12 year old Advanced horse that is on NO injections. Only Cytel M. That is unheard of.

I also find that yucca is a good additive to joint supplements.

purplnurpl
Feb. 7, 2008, 12:51 PM
Adequan is safe IM and IV.

Though if your giving it right before a compeition it may be smarter to give it IV.
Any IM injection can potentially cause a lump and stiffness. Would suck if the one time your horse had a reaction it was two days before your competition.

purplnurpl
Feb. 7, 2008, 12:53 PM
What precisely have scientific studies shown? That the horse has pain relief? that it helps with joint fusion? that it helps slow down degeneration of the joint? that it actually helps heal the joint?

in bold.

actual joint injections help heal the joint. My knee is ex A. : )

LookinSouth
Feb. 7, 2008, 01:41 PM
Adequan is not supposed to make your horse feel better.
It keeps joints from further deterioration.




It is my understanding that it does both to some degree. My ringbone stricken horse had very impressive results after about the 3rd shot of the loading dose. This was a 19 year old ex eventer/OTTB which some serious pathology in his joints. He definitely felt better and was 100% sound with the Adequan. I've known many cases when it's been prescribed for arthritis and joint pain issues not only for help with pain but for joint repair/deterioration preventative as well.

grayarabpony
Feb. 7, 2008, 06:34 PM
Kristiansen and Kold and Todhunter et al. are joint injection studies. I was asking about IM injections.

grayarabpony
Feb. 8, 2008, 08:50 AM
bump

RAyers
Feb. 8, 2008, 09:32 AM
Kristiansen and Kold and Todhunter et al. are joint injection studies. I was asking about IM injections.

The only difference between Adequan IM and Adequan IA is the carrier. Both have had to show proven efficacy in the joint. See work by Kawcek and McIlwraith.

Route of administration in this case has nothing to do with efficacy as the studies show the same molecule gets into the joint.

Reed

RAyers
Feb. 8, 2008, 09:38 AM
What precisely have scientific studies shown? That the horse has pain relief? that it helps with joint fusion? that it helps slow down degeneration of the joint? that it actually helps heal the joint?

Here is the most succinct explanation I can give. If you want specific studies, I suggest using pub-med or Scirus. You will find around 300 articles discussing various applications and tests on joint cartilage and glycosaminoglycans.

Here is an article I published about 10 years ago but it is still relevant. The Legend Adeqaun stuff is in red.


Equine Joints and Current Therapies for Those Who Couldn’t Give a Rat’s Ass

As horsemen and women, one of the primary concerns about the continued welfare of the equine athlete is the health of the joints. Most of you are familiar with the terms degenerative joint disease (DJD) or osteoarthritis (OA). These are general descriptions of numerous conditions (osteochondritis dissecans {OCD}, bone spavin, synovitis, etc.) that can afflict a joint and cause degeneration in the relatively thin cartilage layer that serves as the wear and loading surface in a joint, rendering an animal no longer fit for riding. Until fairly recently, therapies for the treatment of DJD have only treated the symptoms, but failed to address the underlying condition. As our understanding of the biology and physiology of joints increases so does our arsenal of therapies in treating DJD, enhancing the quality of life that our horses enjoy. This article will discuss the current state of the art in veterinary treatments of DJD, covering both common traditional treatments (e.g. intra-articular injections of steroids, sodium hyaluronate, phenylbutazone {bute}, flunixin meglumine {Banamine®}, palosein, etc.), more recently accepted prophylactic treatments (e.g. intravenous injectable sodium hyaluronate {Legend®, Hylagan®, Hylartin®}, polysulfated glycosaminoglycans {Adequan®}), and finishing with what the near and distant future holds in store (directed cytokine therapy, gene therapy). This article by no means is inclusive or endorses any one therapy, but rather it is intended to give the reader a broad overview of what is available to the veterinarian when treating DJD in horses.

In order to give context to pharmacological therapeutics such as Adequan and Legend, it is wise to review the various types and structures of joints. First, there are two basic types of joints that we, as horsemen, are familiar. The first are high motion, or synovial, joints (e.g. stifle, fetlock, upper hock). The second type of joint are low motion such as those found in the spine or the lower (distal) hock (tarsometatarsal joint, distal intertarsal joint). Those hock joints just mentioned are commonly what the veterinarian is treating when injecting various therapeutic agents, implementing a cunean tendonectomy or what are referred to when it is said “the hock has fused”.

Whether the joint is high- or low-motion, certain structures within the joint are similar, with the most important being the hyaline cartilage that overlays the bony substrate. Anybody who has had a drumstick or carved a turkey can recognize hyaline cartilage from the glossy smooth surface present at the end of the bones. It is this surface that must withstand the tremendous compressive and shear stresses imposed upon the limb during athletic competition. In conjunction with withstanding the compressive forces, hyaline cartilage must also provide a near frictionless surface to allow the adjoining bone to move against each other. In hyaline cartilage, nature has created a very unique method to accomplish these tasks.

Hyaline cartilage is made up of collagen held together by glycosaminoglycans (Things are already sounding familiar.). Glycosaminoglycans contain hyaluronic acid, and proteoglycans consisting of chondroitin sulfate and keratin sulfate (Where have you heard about these before?). A rather rough analogy would be that the glycosaminoglycans are the mortar that holds together the collagen, similar to reinforced concrete. Unlike concrete, however, hyaline cartilage is also about 70% water that is tightly bound to the proteoglycans explaining hyaline cartilage’s tremendous resilience without being rigid or brittle.

Maintaining the appropriate environment and lubrication of the joint is accomplished by a simple appearing, yet complex structure called the synovium, hence the alternative name for high motion joints mention previously. Healthy synovium appears as snow-white deep pile shag carpeting in arthroscopic images. The cells within this structure secrete synovial fluid that, in normal instances, is a transparent yellow (like vegetable oil) and is very viscous, similar to heavy-duty gear oil. Because of its high vasularization, the synovium is also the primary source of nutrients for the articular surface (which due to its avascular nature absorbs nutrients directly from the synovial fluid) and regulates any inflammatory response in the joint capsule. Thus the condition of the synovium plays a significant role in the overall health of the joint.

Inflammation of the synovial membrane can result in the release of destructive enzymes and prostaglandins that can cause degradation of hyaline cartilage, while the generation of radical oxygen in the extracellular space in the synovium that can significantly degrade hyaluronic acid and cartilage proteoglycans. Because the articular surface of a joint has no nerves, pain associated with degeneration is not felt. It is only when nerves within the synovium and the peri-articular regions are stimulated that the horse perceives pain and becomes lame. Therefore, an inflammatory condition in a joint can persists for a sufficient amount of time such that damage to the articular surface occurs before the horse perceives it.

Treatments for DJD seek to ameliorate inflammation within the synovial membrane while damage to the articular surface remains. One method is to use steroidal and nonsteroidal anti-inflammatory (NSAIDS) drugs. A NSAID such as phenybutazone is used to block prostaglandins (specifically PGE2), but it has recently been shown that extended use of bute will actually exacerbate OA. While the role of PGE2 in cartilage degradation is still subject to interpretation, recent research has shown that over longer periods of time PGE2 will subsequently inhibit resorption, protecting the cartilage. Because bute binds to the PGE2 to inhibit pain and inflammation, it can also inhibit cartilage repair if used for extended periods. Thus it is readily apparent that a delicate balancing act must occur so that the treatment does not become a cause for further cartilage degeneration. Other NSAIDS such as aspirin have a very short half-life in herbivores and thus it is difficult to obtain therapeutic doses in horses. In addition, NSAIDS such as bute and Banamine, have long been established to have the potential to induce ulceration of the esophagus and gastro-intestinal tract, regardless of oral or intravenous administration. The injection of corticosteroids into the joint space inhibits the release of prostaglandins and the destructive enzymes associated with inflammation. Corticosteroids, however, have the disadvantage of inhibiting production of new articular cartilage, again showing the delicate balancing act that occurs to help the body heal.

Palosein (superoxide dismutase) is a very effective antioxidant that can reduce levels of radical oxygen in the interstitial spaces in the synovium protecting hyaluronic acid against breakdown of as well as protecting cells against cellular lysis, thus its anti-inflammatory role. Studies have shown little or no significant side effects such as those seen with NSAIDS or corticosteroids. Its cost, however, is prohibitive to many people. The therapies discussed can be very effective when administered appropriately, but remember each animal is an individual and may not respond similarly to other animals receiving the same treatment.

The current trend in medicine is toward using natural proteins to effect the desired response when treating DJD. Currently this has taken the form of the very popular drugs, sodium hyaluronate (Legend®, Hylartin®) and polysulfated glycosaminoglycans (Adequan®). These drugs still do not address the problem of damage to the articular cartilage, but when administered either prophylactically or as a therapeutic series, they have a tremendous effect on the inflammation within the joint. The advantage of these drugs is that they are “natural” molecules and have few side effects, and as time has progressed they have become quite affordable.

Sodium hyaluronate has been investigated as a therapeutic since 1970. It is primarily effective in treating synovitis (inflammation of the synovial membrane). Although the exact function of sodium hyaluronate is still being elucidated, evidence suggests that it acts to help “normalize” the environment around the synovial membrane. This may be accomplished in several methods. Sodium hyaluronate may help scavenge the radical oxygen present during the inflammatory response thus acting as a mild anti-inflammatory agent. It may also prevent access of inflammatory enzymes to the cartilage by simply “taking up space”. It has also been suggested that sodium hyaluronate helps stabilize the viscosity of synovial fluid aiding in joint lubrication, although this role of sodium hyaluronate in joint lubrication is still subject to debate.

Polysulfated glycosaminoglycans act to inhibit the destructive enzymes associated with the breakdown of articular cartilage. In a sense it acts a decoy by binding to the articular cartilage surface and sacrificing itself to spare the proteoglycans in the hyaline cartilage. In addition it may stimulate hyaluronic acid synthesis.

To summarize these two types of drugs, sodium hyaluronate is primarily an anti-inflammatory that may help stabilize the environment in and around the synovium along with stabilizing the viscosity of the synovial fluid. Adequan protects the articular cartilage (chondroprotective) from the destructive enzymes released in joint inflammation. In both instances neither drug has been shown to reverse damage incurred by hyaline cartilage. That leads us to the next generation of drugs that, in conjunction with anti-inflammatory treatments has been shown to regrow the articular surface, reversing the effects of DJD.

Recent studies examined the effects of a protein called IGF-1 (Insulin-like growth factor-1) in synovial joints. IGF-1 acts on concert with growth hormones to stimulate bone growth. In humans it is used to treat dwarfism and other developmental diseases. This protein stimulates bone growth by acting directly on the chondrocytes (the cells that produce articular cartilage and make bones grow longer). In a previous study in dogs, and in current human clinical trials, DJD has been completely reversed and a quality articular surface has been regrown using a treatment including IGF-1. It is likely that we will see this available to the horse world in 10-15 years as a common method of treatment. At the moment, however, treatment of a single hock joint in a horse would be prohibitively expensive (upwards of $1,000 per injection for a series of 12 injections) based upon the author’s research experience with IGF-1.

Slightly further down the road, 15-30 years, are genetic treatments. Researchers at CSU’s school of Veterinary Medicine are beginning to develop gene transfer as a way to reprogram the cells of the joint to release growth factors, anti-cytokine molecules to name a few possibilities. This method offers great versatility and may allow for the direct manipulation of the healing and growth process within a joint after orthopedic or arthroscopic procedures, or as an alternative therapy for DJD.
This series of articles is only intended to be an overview of what DJD is and some of the common therapies available to the veterinarian and owner. Nutraceuticals (nutritional supplements) were not included in this discussion due to the limited number of studies outlining their efficacy. There is sufficient anecdotal evidence, however, to suggest that they may be very effective in aiding the treatments discussed herein in helping the horse stay sound. Suffice to say, the best treatment is to refer to your veterinarian when confronted with a lameness problem and follow the proposed course of treatment. For the interested reader, there are numerous excellent books and articles on equine lameness and its treatment that your veterinarian or this author can recommend.

grayarabpony
Feb. 8, 2008, 11:16 AM
Thank you for posting all of that Reed.

My TB/ Han has been on IM monthly Adequan shots for over a year, and started with the 7-shot loading course. I have not been able to tell any difference because his primary problem was a high rear suspensory injury -- but his right hock did show 2 small bone spurs on x-ray, so after talking to the vet we put him on Adequan. He has since had nerve resection for the suspensory ligament injury and is sound.

grayarabpony
Feb. 18, 2008, 02:57 PM
I just read White et al, 1993. Research was funded by Luitpold Pharmaceuticals, manufacturers of Adequan, and took place at the Sallisaw Equine Clinic.

30 horses were subjected to the Complete Freund's Adjuvant, an injection which produces radiographic evidence of DJD within 4 fours with no treatment. 5 days after being subjected to CFA, the horses were split into 3 groups treated with 500mg/ 5 mL IM of PSGAG (Adequan, standard dose), acetyl-d-glucosamine or Chondroitin monosulfate every 4 days for 4 weeks. Acetyl-d-glucosamine and Chondroitin monosulfate are often sold as generic Adequan.

Adequan was significantly more effective than the other two compounds. By day 33, horses receiving Adequan improved 87% over baseline scores of lameness, versus about 50% for the other two. Measurements of stride length improved 100% with Adequan, versus 60% for the other 2. Hock flexion improved 80% with Adequan versus 40% for the other 2.

This study did not involve any radiographic or MRI studies of the subjects, and only reports improvement seen from a loading dose of Adequan.

Spoilsport
Feb. 18, 2008, 06:53 PM
Has anyone answered the original question: Do monthly IM Adequan injections really do any good?

There is lots of evidence that joint injections with Adequan benefit the horse. There is also evidence that giving IM Adequan per Luitpold's instructions - every 4 days for 28 days - benefits the horse. But do the monthly IM shots make any difference? I recently recall reading that it only stays in the system a very short time, peaking at 72 hours or something like that. I have the package insert right here, and it doesn't anything about monthly injections. It says "500 mg every 4 days for 28 days."

Has anyone tried calling Luitpold and asked them about the benefit of the once-a-month injections? I wonder what they would say.

I do have my horses on monthly Adequan, but just recently have been having second thoughts, wondering even if it makes more sense to do the "loading dosage" twice a year instead of the monthly shots.

deltawave
Feb. 18, 2008, 08:05 PM
Unless a particular regimen has been studied, it's going to be really hard to say. My guess is that the "monthly" regimen is/was designed for convenience and ease of remembering, rather than with any particular biochemical plan in mind. :) That's not to say it isn't effective, but that kind of question requires research to answer formally, and that kind of study is, of course, SADLY lacking in the entire equine pharmaceutical realm.

Extrapolation is our best bet. Nobody can really say if every four weeks is optimal, or every 3 weeks, or every five, etc. This is way outside the realm of what is known.

JER
Feb. 18, 2008, 08:19 PM
Here's some bad science:

The Luitpold Animal Health website has a section for Adequan I.M. (http://www.luitpoldanimalhealth.com/Adequan_balanced.htm). In the lower left corner, there's another menu in small green print. Among the choices, you'll see Proof Adequan Works (http://www.luitpoldanimalhealth.com/Adequan_proof.htm).

Click on that and you get a page that has three quotes from happy Adequan users. Todd Starr, billed only as "Horse Owner" says "I've tried it once and I've never tried another brand again!" The two other users, although more voluble than Todd, are "Amazed!" and "Immediately had a different horse!"

Crikey. That's what Luitpold is calling 'proof' that Adequan works?

grayarabpony
Feb. 18, 2008, 09:21 PM
The whole reason I'm reading these articles (one at a time) is that the original question has not yet been answered. And I have a feeling that the research articles aren't going to tell me the whole story either, but at least I'll have read them, instead of reading very vague posts from others that contradict each other.

Appassionato
Feb. 18, 2008, 09:35 PM
Unless a particular regimen has been studied, it's going to be really hard to say. My guess is that the "monthly" regimen is/was designed for convenience and ease of remembering, rather than with any particular biochemical plan in mind. :) That's not to say it isn't effective, but that kind of question requires research to answer formally, and that kind of study is, of course, SADLY lacking in the entire equine pharmaceutical realm.

Extrapolation is our best bet. Nobody can really say if every four weeks is optimal, or every 3 weeks, or every five, etc. This is way outside the realm of what is known.

The parts I put in bold, was RAyers answer above:

"Polysulfated glycosaminoglycans act to inhibit the destructive enzymes associated with the breakdown of articular cartilage. In a sense it acts a decoy by binding to the articular cartilage surface and sacrificing itself to spare the proteoglycans in the hyaline cartilage."

...ever tested? Just curious and just asking! maybe RAyers can elaborate.

Otherwise, I really don't know what studies were done, I just listened to those more familiar with the product (like my lameness/founder vet as well as RAyers). FWIW, my horse did show improvement, possibly due to less inflammation in the joint. <shrugs shoulders>

grayarabpony
Feb. 19, 2008, 09:05 AM
That's what I have done too -- however my horse is getting this as a preventative to any more damage, as his lameness was caused by a suspensory injury.

I will post as I read these articles -- maybe it will help -- but I imagine many questions will remain unanswered, such as do monthly injections really help, or just the loading dose.

deltawave
Feb. 19, 2008, 10:26 AM
We can never know everything. The way I see it, these injectables have demonstrated beneficial effects on the cartilage of arthritic animals. Whether they "cure" or "prevent" anything is unknown. But given the minimal downside, I elect to use them. One can definitely make the argument (minimal downside) for oral products, but those are lacking ANY data in terms of cartilage "quieting" or anti-inflammatory effect, etc. What you have with the orals is a massive amount of hype and speculation and NO data. With Adequan (and Legend, although I'm less familiar with it) you have SOME good data, at least.

It's not like complicated regimens of chemo, blood thinners or antibiotics where you have a known disease entity, a known, proven regimen that works precisely with this or that dose for this particular type of individual. It's WAY less well hashed-out than that.

Spoilsport
Feb. 19, 2008, 10:57 AM
I called Luitpold and asked. Their explanation made sense and convinced me that there is at least good possibility that the monthly injections benefit the horse. Initially I was going to summarize what they told me here, but I am not a scientist and I know how things get butchered on the internet ;) so suggest others who are interested call. Their # is 800-458-0163.

HappyTalk
Feb. 19, 2008, 10:59 AM
JMO...after the loading dose, once a month did not appear to benefit my horse. I currently use it twice a month. If I could afford it, I probably would go to once every 10 days as a mintenance schedule.

grayarabpony
Feb. 19, 2008, 11:03 AM
You're talking to salespeople when you call Luitpold -- I'd rather read the studies and assess them for myself.

Renn/aissance
Feb. 19, 2008, 11:48 AM
I switched from Corta-Flx w/ HA to Adequan about a year ago (per my founder vet), and have really noticed improvement! When Bo was diagnosed in December with a joint trying to fuse, going to a shot once a week for about 6 weeks helped with soundness issues. I haven't re-xrayed the joint yet, but the vet mentioned that Adequan sometimes helps with joint fusion for joints already in the process of fusing (I think from his experience). In any case, my horse felt better and that was all that mattered to me. I still need to get the joint re-x-rayed though. ;)

I use both Corta-Flx HA and Ichon (an Adequan derivative). I give the Ichon about every three weeks to a month; I try to give it a few days before a horse show. Has made a big difference with Mr. Tip, who has had a few hock and fetlock injections in his lifetime. He moves much more freely after he's had his Ichon. I've tried them both independently of each other and I really like the combination best.

Spoilsport
Feb. 19, 2008, 02:38 PM
You're talking to salespeople when you call Luitpold -- I'd rather read the studies and assess them for myself.

As far as I know, there are no studies on the efficacy of monthly IM Adequan. I spoke to a "tech" who was probably a salesperson :lol:, and I took what he said with a grain of salt. I was simply curious as to what they would said. Obviously, drug companies have an interest in selling their product, but, in my experience, they also have an interest in covering their you-know-what.

The OP claimed that Dr. Oglesby said "clinical studies have shown that monthly IM Adequan injections are basically useless" (verbatim quote). I think what he said is "there are many folks who question the usefulness of monthly Adequan." Dr. Oglesby himself may question the usefulness, but he did not refer to clinical studies and, to my knowledge, there are none ;) So I also take everything I read on the inetrent with ahealthy grain of salt :lol:

grayarabpony
Feb. 19, 2008, 05:15 PM
Spoilsport, Dr. Olgsby stated his opinion in a stronger way than the way in which you quoted him. I have membership to that site so I've read all of his posts on the subject to date.

I had been wondering if the monthly doses of Adequan do any good anyway, which is why I was looking up the use of IM Adequan on that site. $500 a year is a lot of carrots and peppermints.

Spoilsport
Feb. 19, 2008, 05:48 PM
Spoilsport, Dr. Olgsby stated his opinion in a stronger way than the way in which you quoted him. I have membership to that site so I've read all of his posts on the subject to date.


What I quoted was from the visitor's section of his site. True. So, in the members-only section, did Dr. O say that there are clinical studies showing that monthly IM Adequan doesn't work? Can you give me citations to those studies? I'm not trying to be argumentative. I'm interested for the same reasons you are. Heck, if monthly Adequan is useless, I'd rather spend the money on massages for my horses - or myself :winkgrin:

Samotis
Feb. 19, 2008, 06:06 PM
I may be going out on a limb here, but I think that Adequan works different in every horse. Each horse has different issues and while Adequan might do wonders on some, it may not affect others. I would thinkt that any injectable would work better then oral.

Take a look at your horse and why you are giving the Adequan to them. Adequan works over time, where legend has an automatic anti-inflammatory effect, so a combination of both on a show schedule might be most beneficial.

My old guy doesn't show a lot anymore, so I give him Adequan when I can afford it, but he doesn't need Legend anymore. (he did get legend when he was showing in the 3'6 hunters)

moribelle
Feb. 19, 2008, 07:43 PM
Basically, what is the problem with your horse to make you want to use adequan?
There are other ways to treat him/her depending on what the problem is?
Sherry

grayarabpony
Feb. 19, 2008, 11:27 PM
Spoiledsweet, I have looked through the references and there aren't any studies supporting the use of monthly IM Adequan. Edited to add: The studies involve the every-four-day loading dose, and the studies I've looked at so far were short term. The longest study was 11 weeks.

I also sent you a PM.

vxf111
Feb. 20, 2008, 03:56 PM
I have 3 horses on Adequan, all at very different stages of development. I have a 19 year old (his b-day is Thursday) QH pony who was used HARD as a barrel horse in his younger days. An 8 year old OTTB who had West Nile and lyme which really ravaged his body. Finally, an 8 year old WB with pretty much minimal wear and tear. I have firsthand SEEN the difference Adequan has made to all 3 horses. The difference is especially evident in the quarterpony. I can FEEL when he's gotten his monthly shot. For all 3, I did the recommended loading dose followed by monthly injections.

I will say, however, that the effects took longer to be seen in the different horses. In the quarterpony, he was a different animal during the loading dose. In the WB, he felt the same in the loading dose, it took a few months for me to see a difference. IMHO, the "worse off" the horse is, in terms of arthritis, the quicker you see a difference. All horses are different too. I think doing the shot more than once/month after the loading dose would create even more striking results. For me, once a month has been sufficient.

I have seen too many horses, including my own, benefit from Adequan to say it doesn't work. It's not a miracle cure for every horse, but it ABSOLUTELY makes a discernable difference for many horses. Given the effects I have seen, it's worth what it costs and then some. I honestly don't believe the quarterpony would still be jumping and riding 6 days/week if it wasn't for Adequan.

touchstone-
Feb. 21, 2008, 04:57 PM
This is a fascinating thread, and I only wish there were clearer answers.

I have an old jumper who's been on Adequan for years, and I too am wondering whether he'd be better served by periodic 7-shot-series instead of the twice-a-month shots he gets now. Unlike other posters, I've never noticed any real effect in his movement from a single treatment, but I never really expected to. I'm more interested in protecting his joints since they've already seen a lot of wear and tear, though I certainly wouldn't complain if it improved his soundness too.

I wish that more vets would at least do a rigorous record-keeping of their customers' anecdotal experiences. I've come to terms with the fact that there wont' be any large population-based studies on this stuff, but it would probably be helpful to see what the big sports medicine practices have seen for results with varied treatment regimens--just at the level of customer feedback, performance and xrays on subsequent checkups. It's certainly not random and blind, but I'm sure they already have a decent amount of variation in what their customers use.

I guess I'll add this to my list of questions for the vet. He's been supportive of the current schedule, but wonder what he'll say when I put the choice to him.

grayarabpony
Feb. 22, 2008, 01:24 PM
I just finished reading a 1996 review paper by Jones et al. Jones is (or was) at the Vet School at Mississippi State.

-- IM injections of 500mg/ 5 mL Adequan induces serum PSGAG (Adequan) levels comptaible to those occuring after IA injections. After IM injection, synovial fluid levels peak at 2 hours, and therapeutic levels were acheived and maintained up to 96 hours. There is higher uptake in inflamed joints, and in knee and hock versus fetlock and coffin bone. In other words, whether Adequan is injected into the muscle or the joint, some of the Adequan is absorbed into the bloodstream and some goes to the joint and reaches therapeutic levels. Some of these studies were done with rabbits, man, and horses. The study involving synovial fluid uptake used horses and is Collier et al: 3H-PSGAG concentrations in synovial fluid of equine coffin joints following a 500 mg intramuscular injection.

-- Adequan has been shown to inhibit enzymatic degradations of cartiledge matrix and inflammatory factors like prostaglandins andtoxic oxygen radical production. Two of the studies were in vitro rather than living animals and the third I'm not sure about: it's Rashmir-Raven et al, Inhibition of equine complement activity by PSGAG.

-- Human recombinant insulin-like growth factor (rh-GF-1) has been shown to aid in cartiledge maintenance and healing. In the 2 studies cited, one used horses as subject and another used pigs. Whether Adequan has the same effect has not been scientifically established.

-- Adequan has been shown to increase synovial HA by more than 50% within 24-48 hours of administration. This was demonstrated in the 1993 Collier at al study.

-- The review states that no studies have been done demonstrating the use of IM Adequan with different combinations IA Adequan, IA HA, IA steroids, NSAIDS, and exercise. There are no prophylactic studies conducted in horses, although single monthly injections are often adminstered.

RAyers
Feb. 22, 2008, 02:04 PM
Excellent synopsis. Thanks!

A side note,

There are other IGF-1 studies out there. We flew IGF-1 on a Space Shuttle mission, STS-77, to look at its bone sparing effects in spaceflight. I know of 2 or 3 dog IGF-1 joint studies that showed excellent results in combination with some anti-inflammatory therapy.

There is NO maker of clinical IGF-1 because it is too expensive to produce. Thus it will come to market via genetic engineering (a PROCESS, not drug). One of my old collaborators found that pure IGF-1 does not work well in joints without several other specific proteins (IGF binding proteins), another reason the drug company abandoned the drug form.

Reed

ThreeHorseNight
Feb. 23, 2008, 12:42 AM
I just finished reading a 1996 review paper by Jones et al. Jones is (or was) at the Vet School at Mississippi State.

-- IM injections of 500mg/ 5 mL Adequan induces serum PSGAG (Adequan) levels comptaible to those occuring after IA injections. After IM injection, synovial fluid levels peak at 2 hours, and therapeutic levels were acheived and maintained up to 96 hours.


So what happens after 96 hours? I assume the serum level drops? How much does it drop? Does that mean that after 96 hours, I'm not getting any benefit from the Adequan? Is that why initially you do 7 injections, 4 days (96 hours) apart? What happens when you go to a once a month maintenance dose? After the initial loading period, are the serum levels high enough that a once a month injection can sustain the levels?

Inquiring minds want to know.

deltawave
Feb. 23, 2008, 09:07 AM
Unfortunately, without a study designed to PRECISELY answer those questions, inquiring minds won't have much of an answer. :)

Not all drugs require a steady blood level to work, and I'm not sure there is a "minimum required concentration" established. Serum levels may also not correlate at all with levels in the synovium.

More study is clearly needed. The initial "every four day" regimen may very well be based on studies of serum levels, but you'd have to dig a lot deeper to see if that (the serum level) was simply something they picked at random or actually measured WRT efficacy in the joint.

Spoilsport
Feb. 23, 2008, 09:15 AM
Really interesting reading and good questions!

I don't think serum (blood) levels mean much. What I would look at is the synovial fluid levels. In other words, how much of the IM Adequan actually gets to the synovial fluid in the joint? The studies graypony summarized show that it does somehow get to the synovial fluid:


synovial fluid levels peak at 2 hours and therapeutic levels were acheived and maintained up to 96 hours


some of the Adequan is absorbed into the bloodstream and some goes to the joint and reaches therapeutic levels

My interpretation of this is that if you took synovial fluid samples after 96 hours you would not find measurable levels of Adequan, but that doesn't necessarily mean it doesn't benefit the horse.

This would be my question: Does having therapeutic levels of Adequan in the joints for up to 96 hours every month benefit the horse over the long term?

I called Luitpold b/c I wanted to hear what they had to say. I identified myself as a lawyer. They gave a good general explanation of how Adequan is thought to work (same thing I can find in the literature), but they never came right out and recommended monthly IM Adequan. The monthly dose isn't mentioned in any of the the Luitpold literature, and I find that telling. My guess is they can't recommend the monthly use of IM Adequan because they don't have any data showing that it works. But just because they don't have the data doesn't mean it doesn't benefit the horse. Clear as mud :lol:?

To the last poster: it is my understanding that they measured both serum and synovial fluid levels.

One more thing. I recall reading but can't find the it now that it gets to some joints more easily than others.

LOL, in my web search I came across this letter from the FDA to Luitpold:

FDA Letter to Luitpold (http://www.fda.gov/cvm/Documents/Adequan_08172007.pdf)

deltawave
Feb. 23, 2008, 09:22 AM
They sort of can't recommend monthly dosing, as it's considered "off label".

Spoilsport
Feb. 23, 2008, 09:28 AM
They sort of can't recommend monthly dosing, as it's considered "off label".

Yes, exactly! I think you and are saying the same things in our last couple of posts. I'm just wordier :lol:

grayarabpony
Feb. 23, 2008, 09:49 PM
So what happens after 96 hours? I assume the serum level drops? How much does it drop? Does that mean that after 96 hours, I'm not getting any benefit from the Adequan? Is that why initially you do 7 injections, 4 days (96 hours) apart? What happens when you go to a once a month maintenance dose? After the initial loading period, are the serum levels high enough that a once a month injection can sustain the levels?

Inquiring minds want to know.


Obviously the synovial levels fall off after 96 hours. Which doesn't mean that Adequan isn't necessarily having an effect, since it increases the amount of HA in the joint. My original post already asked these questions, and I read the articles looking for answers.

Adequan injected IM goes to all joints, but has higher uptake (to therapeutic levels) in inflamed joints and the hock and knee joints. Luitpold has not done studies to support the monthly use of Adequan, and neither has an independent institution. Luitpold did just enough studies to demonstrate its efficacy for the loading dose, and that's all it's going to do. Either Luitpold did the studies on monthly Adequan and efficacy was not shown, or more likely, Luitpold never did any studies on monthly Adequan. A drug company is not required to publish negative data, and it may only need to report data if the drug is shown to be harmful to the horse.

deltawave
Feb. 24, 2008, 08:26 AM
PRE-cisely. The answer is not "it does work" or "it doesn't work" as a monthly dose. The answer is UNKNOWN.

keepthelegend
Feb. 24, 2008, 11:40 AM
I have found polyglycan injections to give a much more obvious result

grayarabpony
Feb. 24, 2008, 01:01 PM
Polyglycan is: purified Hyaluronic acid, Chondroitin sulfates A-and-C in a 10% solution of N-acetyl-D-glucosamine.
It is approved for IA use.

Here is another thread on polyglycan: http://www.chronicleforums.com/Forum/showthread.php?t=130994&highlight=polyglycan.

amazon
Jul. 10, 2009, 12:08 PM
if my horse is on the routine adequan injections, 4/7 (which do have wonderful results) and is in the middle of the regiment do i really need to do the loading dose of cosequin asu if i want to add that to my smartpak?

tia

Torri Maxwell, DVM
Oct. 8, 2010, 02:52 PM
really do any good? What has the literature shown overall? I was just over at horseadvice.com and the vet who runs the site claims that clinical studies have shown that monthly IM Adequan injections are basically useless. I have a biology degree but I have no desire to wade through all of the literature. Anyone here in the veterinary field or who has had an in-depth discussion with their vet care to chime in?

Thank you.

I think I can help you from wading thru all that literaure, and there is a ton of it!! Adequan is an FDA approved drug that has direct benefit on articualr cartilage inside the joint enviorment. With degenerative joint disease such a slow process the return to a normal joint enviorment is also a slow process. Adequan has the greatest benefits to aid the joint back to a functional state if administered as it states on the box insert. The dose of 500 mg/kg (one shot/1000 lb horse) every four days for seven treatments is key. If people report that the drug has not worked it is usually that they have a modified dose downward and get downward results.

grayarabpony
Oct. 9, 2010, 03:12 PM
Torri, what do you think of loading 2 loading doses per year then?

Villager
Oct. 9, 2010, 10:36 PM
Best present ever for our old family show jumper pony who turned 25 this August. She was a little 'spit fire' in her youth and now is a little 'sedan' in her old age.Always and active mare,I believe her constant moving in her paddock keeps her less stiff.

Early this summer, another trainer suggested she leave from a pony club show due to looking unsound. While the vet was out doing shots, I asked what next, in order to keep her going as she really wants a job. Vet found her symptoms to be purely age related, slight arthritus in fetlocks and hip,and feet needed pads in the front. Vet suggested I splurge for her 25th and try the Adequin, since years of Cortaflex HA and Recovery EQ weren't appearing to change anything.. We did the month fill up(nearly broke the bank) and I am committed to giving her monthly Adequin for life. She is part of the family and worth every penny, even though the kids are grown and long gone.
She is ridden 5 days a week, in drill team, beginner cross-pole lessons, short road hacks and disabled riding.
I did not tell the riding instructors or leasors about the treatment( I wanted to see if they noticed) By the third week, they were all commenting that she looked like a hot new pony...she was move flexible and moving more fluidly. Her movement much lesson choppy and back to charging the little poles in her old jumper style. This is all anecdotal...but the feedback I have had from trainers, riders, farrier,has been very noticeable...with the Adequan and shoe pads, she has gained 5 more years back of her life...which puts her at 20!

aucowwy
Oct. 10, 2010, 01:21 AM
A study
http://www.fda.gov/AnimalVeterinary/Products/ApprovedAnimalDrugProducts/FOIADrugSummaries/UCM054846

Cowgirl
Oct. 10, 2010, 02:26 AM
The research that adequan has done indicates that the series, as prescribed (7 shots every four days) DOES have positive benefits. All three of my vets concurred that there is a cumulative beneficial effect to dosing adequan this way that you don't get from a single shot. I also somewhere read that you don't see the full effects of the injections you give today for like eight weeks. Here, the vets recommend a loading dose and a monthly shot, but friends of mine in top sport in another part of the country say the vets recommend two to four loading series per year, and that's it. If I do loading in spring and fall AND a montly shot, it's 24 shots, which cost me $30 per shot (10dose tank at my vet's cost), a total of $720 or $60 per months spread over a year. The value I get is beyond what I get for an oral supplement. I also give a monthly legend shot and alternate the shots every other week. I do Legend weekly during show season.

I do like cetyl myrastoleate though--it was a godsend for my old horse.

sptraining
Oct. 10, 2010, 10:49 AM
I'd have to believe that it wouldn't be popular if it didn't help the horses somehow...

My vet is having great success with polyglycan. I just started a horse on it (yesterday was the third loading dose) and I can already see a difference. Warm up time/stiffness coming out of the stall is decreasing. Horse seems happier and more willing to do the job. So far, I'm really happy with it and the cost doesn't break the bank.

TrotTrotPumpkn
Oct. 11, 2010, 01:44 PM
I did Adequan IM on a TB who flexed positive in her hocks. It did not make a difference in flexions, or movement observed pre or post-Adequan. Horse was given the loading dose, as prescribed. Last flexions were one month after starting the regimine and were not done again, so I do not know if there was a benefit further out. The horse had hock arthritis, per x-rays. X-rays were taking a year prior to any symptoms and then the month following the beginning of treatment. While they were worse the second time, I did not have x-rays taken immediately prior to the treatment, so I don't know that they prove anything.

What did make a difference (in movement and flexions) was hock injections.

Now I'm not saying that Adequan doesn't work. That's not my point. It just wasn't a dramatic/wonderful thing in this one case. What did make a dramatic improvement was injecting the joint.

It would have been interesting to continue with the therapy with a series of x-rays, but that was out of the budget.

I question the value of monthly injections, but am open to studies proving validity--doesn't one shot last about 4 days?

foshigan
Aug. 26, 2011, 04:37 PM
Not sure if this thread is still alive, it has been almost a year later since the last post, but if anyone is still out there - please respond... I have made a decision to put my 5yo ottb on Adequan. I was suggested by my vet to do it about a year ago, but she said to try Recovery first. After a year of recovery I am not seeing noticeable improvement, his stiffness is still present, and some days it is lameness rather than stiffness…

I picked up Adequan from my vet last night, but the recommended dose for us was not 4/7 as written everywhere, but 1 shot every 2 weeks for 4 weeks… Now I am confused – is there more than 1 version of Adequan I.M. available on the market – or my vet is suggesting something liberal based on her own opinion? I also called the clinic to find out if when I am done these 4 shots I need to pick up more, but she advised me that this is it for now and we will see what we do down the road… Am I wasting my money doing this?

Can you please let me know if anyone has been suggested or heard of this regiment: 1 shot every 2 weeks for 4 shots in total?

Thanks!

qhwpmare
Aug. 26, 2011, 06:45 PM
Never heard of that regimen...loading dose is 1 vial every four days 7x for a total of 28 days to complete the cycle. Did it for my gelding and saw no difference...he had minor arthritic changes confirmed by xrays of the hocks.

Highflyer
Aug. 26, 2011, 09:35 PM
4/7 is the protocol currently recommended by the company. In the past I believe it was a dose every week for 4 weeks, then a dose a month.

Many vets have their own recommendations based on anecdotal experience, or how they read and remembered the literature, or what is affordable, or what they think the client wants to hear, etc., etc. which is probably the case for you. 4/7 is the gold standard, and for a horse that already HAS lameness issues (vs. one getting it as a preventative) I would probably go that route. But it might be worth asking the vet what their reasoning was.

UrbanHennery
Aug. 27, 2011, 01:52 AM
I'd agree that as much as anything else it depends on the vet. Mine recommends 4 shots, 4 days apart as a starting loading dose. I did that earlier this summer and found an immediate difference in my not really lame, just stiff, gelding. So much so that I was going to call the vet and get 3 more vials to finish the gold standard. But then he got hurt and we decided not to worry about it until he's back under saddle. :(