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View Full Version : Interesting article on Legend IV vs Adequan IM vs (Pentosan IM pg 2)



Lieslot
Jul. 19, 2010, 08:43 AM
http://www.ctrdvm.com/html/medications.html

Perhaps many of you already knew this but I was somewhat surprised to read about the effectiveness or in my newly formed opinion now, uneffectiveness (longterm) of Legend, due to its very short acting effect plus it doesn't get into the joint. The latter now has me doubting again if Legend is worth it at all and if IA is just a better way to go.

Things that surprised me :
LEGEND

It does NOT go into any of the joints themselves, but merely attaches to anti-inflammatory receptors on the blood vessel side of the joint capsule. Here it has an even stronger anti-inflammatory than when placed within a joint! As it does not enter the joints, there is no lubrication effect when given intravenously(IV). Remember too, it is only an anti-inflammatory for joint related issues. The duration of its anti-inflammatory effect when given IV is anywhere from 2 to 7 days maximum. Because it works well for these short periods and is a naturally occurring substance I consider it: “The bute for JOINTS that does NOT test.” There is NO long term benefit from Legend

ADEQUAN

In several studies Adequan has been shown to go to joints once injected and actually be incorporated into production of new cartilage. The dose of Adequan you give today helps you best eight weeks from now. This is because Adequan works to heal damaged cartilage. The process of healing damaged cartilage takes time, at least eight weeks for a significant defect. Although there is some anti-inflammatory effect right away from an Adequan injection, this is very minor and not reliable for keeping horses sound in competition

I'm just curious how many of you are (did) combining (combine) both products and how frequent do (did) you inject and do you feel it's worth it combining or are you happy with regular use of just 'one' of the above, which one and how often.

Thanks!

PS, PENTOSAN mentioning on pg2

NorCalDressage
Jul. 19, 2010, 09:14 AM
Checked out the link. That page makes it unclear if that information is written by Craig T Roberts or those are comments by Gary White - the link for that article is broken.

Frankly, I'm doubting what is said here about Legend.

DMK
Jul. 19, 2010, 09:36 AM
well it does look to be just a tad heavy on the adequan promo side, so I would prefer to see something a bit more independent... however if legend - I meant to type "legend" (doh - not adequan) does nothing more than reduce inflammation on the receptors (which is vaguely what I recall it to do and be advertised as nothing more or less than that) then it does help the viscosity within the joint. It's that inflammation that breaks down the viscosity of the joint fluid and contributes to long term damage. Typically I've heard Legend is better before the arthritic damage is done and adequan is better later in the disease stages. You know, they do different things and need to be used at different times. I don't think they are or have ever been advertised as interchangeable.

The linked page sort of reminded me of the spin that states the obvious and then repackages it so you think it's awesome: Green? You don't need GREEN! You need to mix up blue and yellow! Blue and yellow are far superior to green!

Lieslot
Jul. 19, 2010, 09:38 AM
I was surprised too to read that about Legend.


the link for that article is broken.
Hmmm weird, does it work when you go
http://www.ctrdvm.com/, select "equine healthcare" at bottom and then go to the bottom 2 links :
- more.... about Adequan
- more.... about Legend

or these :
http://www.ctrdvm.com/html/medications_adequan.html
http://www.ctrdvm.com/html/medications_legend.html

Fharoah
Jul. 20, 2010, 01:33 AM
I actually found a great improvement when I was giving adequan every two weeks. I think it can't hurt to give bi weekly or once weekly and see if you notice a difference for a month.

Lieslot
Jul. 20, 2010, 08:31 AM
I don't think anyone would dispute Legend doesn't work.
I was merely looking at it from a point of longterm effectiveness.

I guess I wasn't clued up enough and somehow thought if you did a Legend monthly with a (bi-)weekly Adequan that was a great thing. Now I come to wonder if Craig T R. is correct that Legend is only effective for 2 days (if lucky 7 days), unless one can afford to inject their horse every other day, then I'm wondering if it's worth it.
I can see it making sense prior to competition, but perhaps not so much as part of a maintenance program.

On the Bayer website I can't see any mentioning on how long it's effective, nor any mentioning of where the substance actually goes in or attached around the joint. As you say they probably don't know. That's okay, I believe it works, I was just wondering if how long and when or why one would use Legend. I had a misconception of the drug in the past I guess, thinking you could use it as a maintenance thing, well you still can, if you can afford to inject more then once a week, else it now seems to me it may be a drop on a hot plate and not worth the money.

jlrcoats
Jul. 20, 2010, 09:03 AM
Here is what I have always heard. Adequan for boney problems, legend for soft tissue. That is the rule I follow.

Absolut Equestrian
Jul. 20, 2010, 10:46 AM
This is because Adequan works to heal damaged cartilage. The process of healing damaged cartilage takes time, at least eight weeks for a significant defect.

Statements like this drive me absolutely, positively INSANE:mad:

Cartilage DOES NOT HEAL. EVER. That's the problem with articular cartilage...it can not replace itself. Damaged cartilage is replaced with a "hyaline-like" scar tissue that is structurally and functionally inferior to the preexisting cartilage.

Statements like the one above (and by a vet no less :no:) indicate that cartilage "heals." It does not. There is no existing medication or surgical treatment that can heal articular cartilage.

I feel better now.

Signed,
Absolut Equestrian
Obsessive scientist studying articular cartilage repair :D

wendy
Jul. 20, 2010, 11:02 AM
where do you get the idea that cartilage does not heal?
maybe not major tears or severe acute damage, both problems that tend to require surgical intervention, but general wear n tear does get repaired and heal. Very slowly. Lots of studies on the topic and how one might speed up the repair process.

JimmyChoo22
Jul. 20, 2010, 11:36 AM
I posted the same thing yesterday that I am about to say:

My horse had OCD surgery in May & was immediately put on the loading dose of Adequan IM. He had HA-Injections 30 days post-op (aka 4 weeks into the Adequan) and again at 60 days (8 weeks into Adequan). The difference in his joint fluid was significant from 30 to 60 days. My vet said "The Adequan is doing it's job! His joint fluid has substantially improved"....which basically, the first time around with the HA injections, he had NO JOINT FLUID... And now he's finally starting to form the fluid he needs to cushion his joints.

He is also on Cosequin ASU, for additional support.

Absolut Equestrian
Jul. 20, 2010, 02:30 PM
where do you get the idea that cartilage does not heal?
maybe not major tears or severe acute damage, both problems that tend to require surgical intervention, but general wear n tear does get repaired and heal. Very slowly. Lots of studies on the topic and how one might speed up the repair process.

Nope. I'm not aware of a single study that shows damaged cartilage in a mature mammal (humans included) is able to heal ad integrum. It is always replaced with scar tissue, never with chondrocytes which produce an extracellular matrix identical to that found in true articular cartilage.

wendy
Jul. 20, 2010, 02:44 PM
well, since a casual search of the literature turned up hundreds of articles demonstrating cartilage repair in adult mammals I'm not sure what to say in response....

Absolut Equestrian
Jul. 20, 2010, 02:59 PM
Wendy, you have a PM

DMK
Jul. 20, 2010, 03:13 PM
not that good ol' Wiki is much of a reliable authority, but this statement sums it up reasonably well:


The aim of an articular cartilage repair treatment is to restore the surface of an articular joint (http://en.wikipedia.org/wiki/Joint)'s hyaline cartilage (http://en.wikipedia.org/wiki/Hyaline_cartilage). Over the last decades, surgeons and researchers have been working hard to elaborate surgical cartilage repair interventions. Though these solutions do not perfectly restore articular cartilage (http://en.wikipedia.org/wiki/Cartilage), some of the latest technologies start to bring very promising results in repairing cartilage from traumatic injuries (http://en.wikipedia.org/wiki/Articular_cartilage_injuries) or chondropathies (http://en.wikipedia.org/wiki/Chondropathies). These treatments are especially targeted by patients who suffer from articular cartilage damage (http://en.wikipedia.org/wiki/Articular_cartilage_damage). They provide pain relief while at the same time slowing down the progression of damage or considerably delaying joint replacement (http://en.wikipedia.org/wiki/Joint_replacement) (knee replacement (http://en.wikipedia.org/wiki/Knee_replacement)) surgery.

Nothing can restore the cartilage to its former "well oiled machine". You can do a lot of therapies, drugs and surgeries to slow the process of deterioration or ease the pain/improve the functionality of the damaged joint surface, but you cannot yet undo the damage done.

But as soon as someone CAN undo the damage, bjillions will be made.

RAyers
Jul. 20, 2010, 04:32 PM
well, since a casual search of the literature turned up hundreds of articles demonstrating cartilage repair in adult mammals I'm not sure what to say in response....

Uh, are you sure? I have yet to find ANY article that shows repair in mammals and I work in the field (department of orthopaedics). Like Absolut and DMK say....

Reed

ToN Farm
Jul. 20, 2010, 04:59 PM
Whatever, I think some of us would like to know where to put our dollars; in Adequan, Legend, IA injections, or other for those teenage horses that have hock DJD.

I seems that we can't believe anything we read or hear.

Absolut Equestrian
Jul. 20, 2010, 05:11 PM
Uh, are you sure? I have yet to find ANY article that shows repair in mammals and I work in the field (department of orthopaedics). Like Absolut and DMK say....

Reed

Thank you :yes::yes:

RAyers
Jul. 20, 2010, 05:39 PM
Whatever, I think some of us would like to know where to put our dollars; in Adequan, Legend, IA injections, or other for those teenage horses that have hock DJD.

I seems that we can't believe anything we read or hear.

This is where you have to coordinate with you veterinarian. Adequan is more effective on the cartilage directly while Legend is more to stabilize the joint environment.

For the previous post that stated, "And now he's finally starting to form the fluid he needs to cushion his joints..." This is an example of how people are misinformed and subsequently believe an incorrect assumption. Joint fluid does NOT cushion joints or joint surfaces. Many biomechanic studies establish that joint fluid has little function during the movement of joints. Hyaline cartilage has little change in viscosity whether there is fluid or not. Its primary function is nutrient delivery and its structure enables it to survive in a high motion joint. Thus, a watery fluid is more indicative of a failing joint support system than cartilage degradation. Yes, they generally go hand-in-hand but not always.

Reed

Fharoah
Jul. 20, 2010, 05:43 PM
Remember that arthritis causes waxes and wanes naturally and it can be hard to determine what is helping or how much such as turnout and low grade exersise legend adequan or everything. My cusins horse has some more advanced hock arthritis and he was kept sound and showing with regular hock injections steroid HA and monthly adequan. I like IRAP and IA adequan. I can't really afford legend with the vet doing the IV it costs me about $160 did it monthly for a year did it for me more than anything. My vet did say monthly legend would make the joint injections last longer but they did't work for me.

Best Luck

Lieslot
Jul. 20, 2010, 05:45 PM
Whatever, I think some of us would like to know where to put our dollars; in Adequan, Legend, IA injections, or other for those teenage horses that have hock DJD.


So true, this is really why I am out there reading & reading, but with no medical background it's tough and how are we to know which source to trust and which source not to trust.



I have a question for those who are more knowledgeable on the subject.
The reason I'd prefer to start with Legend/Adequan is because of the risks of intra articular injections, small yet real, but also because I cannot figure out whether repeated IA steroid injections actually damage cartilage or not?
Some human or animal articles read that even as much as a single steroid joint injection will damage the integrity of the cartilage and repeated injection will for sure. True or false?

Example of a human medicine article I came across (http://www.caringmedical.com/sports_injury/knee_injury_and_cortisone.asp)

In this study, some of the joints were injected only one time. Even after one steroid injection, cartilage remained biochemically and metabolically impaired. Other studies have confirmed similar harmful effects of steroids on joint and cartilage tissue. A cortisone shot can permanently damage joints

I have to refer to the same vet's article
http://www.ctrdvm.com/html/jointinjections.html

Long term comfort of the horse and relief from the arthritis is the primary goal of lower hock joint treatment, NOT continued motion and flexibility of these low motion areas. This is a very important concept to grasp as joint comfort and treatment for joint function are not necessarily the same. Granted, high motion joint treatments such as Adequan, Legend (intravenous hyaluronic acid), intra-articular hyaluronic acid (HA) and low dose, short acting steroids do play some role in creating comfort. However, all of these drugs are aimed primarily at restoration of a more “normal” joint environment. The primary goal being preservation and regeneration of healthy cartilage. In lower hock joints we often take a different approach. As these joints are not necessary from athletic performance, their more reliable comfort becomes the primary goal somewhat at the expense of the cartilage involved. For this purpose, long acting steroids (the most potent anti-inflammatory available) are used.

As we now know these joints do not play any significant role in the motion of the horse, thus the worst case scenario from such treatment (i.e. continued, progressive joint deterioration and possible increased arthritis production which may be enhanced by steroid injections) may only result in joint fusion. If this were to occur in a high motion joint pasture retirement, at best, would result. In the lower hock joints, however, this results in a pain free performance horse which no longer requires periodic joint injections
To me this reads that when using long acting steroids you are potentially damaging cartilage. But you'd want that for the lower hocks.
But what about short acting steroids & stifle injections for exmple or fetlocks (high motion joints), what is the latest research on cartilage improvement or on the contrary cartilage damage, degeneration by repeated IA injections for maintenance purpose.? I bring this up, coz often when one starts to inject hocks & stifles, one ends up doing so yearly, then going onto 6-mthly or even more frequent. Before I fall into this pattern, I want to understand it better.


Interestingly enough, recent research has down played the significance of long acting steroids in the progression of arthritis in joints (steroid arthropathy). The newest theories support the progressive degeneration regardless of therapies used. Our own clinical experience would somewhat support this as well as many horses appear to progress an fuse despite numerous injections while others apparently never fuse through their entire career even with frequent injections
HUH, in laymen terms? Is he now saying yes degeneration from IA repeat injections (long action steriods) or no? Or horse dependent?
Almost seems to read to me that no matter what you do, inject IA or not, the degeneration will continue to happen, so really you are looking at comfort/pain relief. If that's the case, if one has a non-competing horse, why not bute it? I know bute = gastroenteric probs.

Is it common to inject a joint only with HA and no steroid at all? And as such effective? Perhaps I should have asked this question first, then long acting/short acting steroid, none of it matters anymore, haha ;).
Thanks!!!!

omare
Jul. 20, 2010, 05:53 PM
so which would you use for a horse that should be predisposed to arthritis/joint damage (due to injury) but does not have joint damage/inflamation or unsoundness at this time? Thanks

Fharoah
Jul. 20, 2010, 06:56 PM
http://www.thehorse.com/ViewArticle.aspx?ID=5160

Lieslot
Jul. 20, 2010, 07:08 PM
This is an example of how people are misinformed and subsequently believe an incorrect assumption. Joint fluid does NOT cushion joints or joint surfaces. Many biomechanic studies establish that joint fluid has little function during the movement of joints. Hyaline cartilage has little change in viscosity whether there is fluid or not. Its primary function is nutrient delivery and its structure enables it to survive in a high motion joint. Thus, a watery fluid is more indicative of a failing joint support system than cartilage degradation. Yes, they generally go hand-in-hand but not always
Waw, thanks Reed.
Well in honesty, I have never been aware of anything other then HA lubricating joints, hence cushioning them, hence you need to either inject HA back into the joint or use substances like Legend/Adequan that can get more HA into the joint.
Little do I know... little do I know.
And I swear in some distant past some vet has explained and mentioned the word lubricate joints in relation to HA injections.

The thing is, how much detailed joint education do vets receive during college? Seems to me to get the real bottom answers you need to be talking to orthopedic surgeons. But many of us having horses that are not lame, just performing a little subpar, with no dramatic changes, we will not be hauling horse to the best orthopedic surgeon in the area to make our horse just that little bit more comfortable and hopefully prevent future lameness. Instead most of us try to educate ourselves online, have a brief hopefully more educated conversation with a vet after having done our internet homework and take vet's advice, but never get to the bottom of how it all works, yet we are out there spending $'s on the likes of Adequan/Legend, IA's in an effort to maintain our horses soundness and walk around with our heads in a cloud thinking that the monthly Legend shot we just gave our horse is cushioning his joints.

Thx Fharoah, it actually answered a number of my questions :).

Absolut Equestrian
Jul. 20, 2010, 07:13 PM
I cannot figure out whether repeated IA steroid injections actually damage cartilage or not?
Some human or animal articles read that even as much as a single steroid joint injection will damage the integrity of the cartilage and repeated injection will for sure. True or false?

The short answer is that repeated corticosteriod injections can be detrimental to cartilage metabolism. Several side effects independent of osteoarthritis pathogenesis have been identified (Fubini et al. 2001). Cartilage collected from joints treated with glucocorticoids have pathological changes including chondrocyte cell death, reduced proteoglycan content and rate of synthesis, decreased collagen synthesis and increase in water content (Chunekamarai et al.1989, Richardson et al. 2003). Over time, these changes compromise the structural integrity and biomechanical properties of articular cartilage.

While some glucocorticoids may be helpful for inflamed joints, too much can be very bad. This is where your vet comes in. It's very important to resist the temptation to think that if some is good, more is better! Knowledgeable vets understand this.

There is some really promising research in progress looking at the safety and efficacy of commonly used and novel glucorticoids in horses. Hopefully it won't be too long before some new dosage guidelines are published. In the mean time, have a talk with your vet!

Lieslot
Jul. 20, 2010, 07:21 PM
Thx Absolut Equestrian!
In that case I will (like I was originally planning), see if I can get improvement by using Adequan (most likely) or some Legend first before jumping onto the IA-route, considering horse is not lame, just aging.
I will most certainly discuss with vet, but I want to understand things first so I can ask better questions and grasp what is being explained to me better :cool:.

Fharoah
Jul. 20, 2010, 07:49 PM
McIlwraith adds, "CSU research has shown that MA did have deleterious effects on the articular cartilage. This medicine should be used with caution."

"Triamcinolone acetate (TA) is a potent medium-duration steroid favored in higher motion joints at low dosages," says Black.

McIlwraith continues, "In contrast to the negative effects of MA, work at the CSU Orthopedic Research Laboratory has shown that TA not only had no negative effects, but that it promoted synthesis of essential elements of the articular cartilage. It also appears to be chondroprotective (protecting the cartilage)."

"Betamethasone phosphate is used routinely at our clinic to reduce synovitis and joint inflammation in the young, immature equine athlete," adds Black. "It, too, is a potent anti-inflammatory, but of short duration."

McIlwraith adds, "A study with betamethasone esters showed that they had no deleterious side effects."

ToN Farm
Jul. 20, 2010, 07:53 PM
The short answer is that repeated corticosteriod injections can be detrimental to cartilage metabolism. Several side effects independent of osteoarthritis pathogenesis have been identified (Fubini et al. 2001). Cartilage collected from joints treated with glucocorticoids have pathological changes including chondrocyte cell death, reduced proteoglycan content and rate of synthesis, decreased collagen synthesis and increase in water content (Chunekamarai et al.1989, Richardson et al. 2003). Over time, these changes compromise the structural integrity and biomechanical properties of articular cartilage. Two comments. First, I wonder if giving Adequan regularly in conjunction with IA injections will help offset the detriment to cartilage. Second, if the cartilage is lost, and the joint fuses (talking lower hocks), then that is not a bad thing, according to several articles including the one Liselot referenced.

Lieslot
Jul. 20, 2010, 07:59 PM
Good question and add to that,
IF indeed the ultimate goal of comfort for arthritic lower hockjoints is these joints to fuse (as Craig T described in that article).
Are we then delaying the fusing by injecting the likes of Adequan as a maintenance program. In which case, if one is looking at hock maintenance, one should go straight for IA.
(Boy oh boy, it's getting complicated in my tiny brain)

Lieslot
Jul. 20, 2010, 09:17 PM
Grrrr, nice one, see how crazy it can get when researching the net.
From Craig T R touting the use of Adequan over Legend to the latest research apparently suggesting Adequan IM is only "minimally" effective and Pentosan is where one best puts his/her $$'s.

http://www.thehorse.com/ViewArticle.aspx?ID=15344

ADEQUAN

Polysulfated glycosaminoglycans (PSGAGs, trade name Adequan) Recent research has shown there are different uses for PSGAGs administered intra-articularly and intramuscularly. "Intra-articular Adequan was recently shown to be highly beneficial for inhibiting acute inflammation in the synovial membrane and fibrous joint capsule in the CSU equine OA model," said McIlwraith.

On the other hand, he said, intramuscular Adequan has been tested in the experimental OA model and minimal effectiveness was demonstrated. "Use of Adequan on a 'prophylactic' based continues, and it is certainly agreed that no harm is done," stated McIlwraith. "The beneficial effects still need to be demonstrated, but this is difficult."


PENTOSAN

Pentosan polysulfate McIlwraith said while this drug is not available in the United States, it is available in other parts of the world as Pentosan Equine. "This is an intramuscular product that has been demonstrated as beneficial in the CSU OA model, implying superiority of this product to intramuscular Adequan," he said.

And seemingly a thumbs up for ASU

A clinical trial at CSU with unsaponified avocado soy (Vetoquinol) concluded that the product significantly reduced the severity of joint damage and significantly increased the synthesis of cartilage glycosaminoglycans (i.e., the "building blocks" of articular cartilage) in joints with OA, compared to horses treated with a placebo. McIlwraith said this was the "first well-controlled equine study demonstrating a positive effect with an oral nutraceutical." He said controlled studies of the product in humans also were positive


Again, do we trust this? Who knows....

Fharoah
Jul. 20, 2010, 09:32 PM
Triamcinolone acetate I was told could help preserve the joint. I had a friends horse be injected after months of lameness the horse has remained sound since and no need to inject again this was also the pastern.

DMK
Jul. 20, 2010, 09:44 PM
While some glucocorticoids may be helpful for inflamed joints, too much can be very bad. This is where your vet comes in. It's very important to resist the temptation to think that if some is good, more is better! Knowledgeable vets understand this.

It's also important to understand what is meant by "too often". My favorite giggle moment on this forum is when people comment on getting a horse injected every couple of years and their concern is they will destroy the joint with "too many" injections. I'm not saying that schedule might not finish off a particular horse, but please understand that horse to be an extreme outlier. The standard for a lot of this research is less focused around your 15 year ols performance horse on light duty who might need that injection 1x year for the last 10 years of his life and a LOT more around the implications in the racing industry. And by "too often" the focus starts to be more around a 3 year old who is getting pre-race injections, upwards of 7x year. That's the framework for this discussion. And while I believe that some show horses who get injected 3-4x year are firmly on the "too often" side, again, it's not really holding a candle to where the racing industry is...

DMK
Jul. 20, 2010, 09:48 PM
Again, do we trust this? Who knows....

In the long list of who I do trust in joint research, CSU and McIlwraith do kind of lead the list. If you've been around the block a few times, they have a long track record.

ToN Farm
Jul. 20, 2010, 10:02 PM
In the long list of who I do trust in joint research, CSU and McIlwraith do kind of lead the list. If you've been around the block a few times, they have a long track record.
How does McIlwraith get this latest research information out to the USA vets, or is it their responsibility to scan the net for it? My vet had never heard of Pentosan. Neither did I, until I found out about it on COTH.

DMK
Jul. 20, 2010, 10:10 PM
I think vets who attend the AAEP convention and pay attention to the listserv are on top of most of this info. It's a topic of interest for my vet and she's usually telling me what the latest research is (or I'm asking her about what she's heard on topic X). But vets, they have forums too. Super double secret forums. ;)

And pentosan comes with some implications given the latest legal developments with compounding pharmacies, so I wouldn't be surprised if vets were backing away from that one. Pity, but that is where we are at with the polo pony/selenium/Francks Debacle...

Absolut Equestrian
Jul. 20, 2010, 10:48 PM
In the long list of who I do trust in joint research, CSU and McIlwraith do kind of lead the list. If you've been around the block a few times, they have a long track record.

You have a long list? I'm impressed! :lol:




And seemingly a thumbs up for ASU


Again, do we trust this? Who knows....

Those in the CSU group are certainly some of the leaders in equine cartilage research. I just went back and read the paper about their ASU study (AJVR June 2007, Vol. 68, No. 6, Pages 598-604), and the really interesting part is that I could not find the dose of ASU that they used for the study. Here is all that is included in the article


Unsaponifiable residues of avocado and soybean oils were prepared in a 1:2 (avocado-to-soybean) ratio and mixed in 6 mL of molasses. Placebo treatment consisted of 6 mL of molasses. Palatability was suitable for effective oral administration, and all horses were treated once daily with their respective treatments starting on day 0 and ending on day 70.One of the MAJOR issues with oral joint supplements is their bioavailability. It's entirely possible that the study used many, many times the amount of ASU that is actually in the oral supplement. Maybe it works at the $$$ dose used in the study, but not at the dose actually sold. This is pure speculation on my part, but failure to mention the dose does seem a bit fishy. Another issue is that the content of equine supplements is not regulated. So, you never know if what is on the label is actually in the container.

Another snip from the article:

Among the study horses, the ASU extracts failed to ameliorate the increased lameness, response to joint flexion, and synovial effusion induced by the presence of osteochondral fragments in jointsAre you thoroughly confused yet? :D

DMK
Jul. 20, 2010, 11:00 PM
OK, I lied about the "long" part of the list... ;)

ToN Farm
Jul. 20, 2010, 11:04 PM
It's a topic of interest for my vet and she's usually telling me what the latest research is (or I'm asking her about what she's heard on topic X) Please share. Is Adequan and Legend basically not worth buying or not. If that 2009 document from CSU is the latest, it sounds like my money is going down the tubes buying it.

DMK
Jul. 20, 2010, 11:26 PM
honestly? We formulated a plan that worked for my horse and made him happy. There are no hard and fast guidelines or one size fits all. In his case I started with adequan, and it had no appreciable effect (and at the time I surely was seeing positive improvements when he had HA/depo-medrol IA injections so we knew there was room for improvement) , went to legend and it worked like a dream. After a while I went to a monthly shot of both, staggered 2 weeks apart and that worked really well (all the while doing an annual IA injection). Then I noticed I really was getting a more obvious result from the adequan shots and about that time I decided to retire him and focus on my young horse, so I just went to adequan. And you know what? I still found after 17 months he really needed the IA shot, even with just trail riding and infrequent jumping. Next step is me trying the 7 shot adequan series instead of IA injections. I thought about doing the 7 series when we last did the IA, but I really didn't have the $$ to do both in case it didn't work that well so I went with the sure thing for this horse (IA). But we are just working together to figure out what works for this horse, as simple as that.

But I do know AAEP periodically has discussions/research on which steroid to use, Betamethasone or TA (one had higher risk of joint damage, the other an increased risk of founder), as well as whether or not it was necessary to inject in upper and lower joints, depending on the damage done to the joint, and was that barrier penetrable by HA/steroids, and so on. It's interesting to hear about what's going on in the field even if a lot of it is just early trial work and not hard and fast proven results, but you still need to recognize your horse is an individual and there is no recipe book for this stuff. But we ALL know a good canter and a relaxed rocked back jump when we feel it so you KNOW what is working and what isn't. You just might have to be flexible (i.e., spend $$) in looking for what works for you.

ETA ... while trolling the CSU site, I found this little extraction from the 2009 newsletter about a study of IA adequan versus legend (or other HA such as hylartin)


Clinically, previous reports have suggested that HA might work better
in acute synovitis and PSGAG in osteoarthritis, but the findings in the present study question this. It would seem that HA provides long-term disease-modifying effects to the cartilage and this fits with clinical experience in man, where it is often necessary to have to go six months follow-up to see any benefit with intra-articular HA. It also explains why a dramatic decrease in synovitis was not typically noted when HA was used alone and why many
veterinarians use HA in combination with intra-articular corticosteroids to get symptomatic relief at the same time the HA is offering a long-term disease-modifying effect. On the other hand with PSGAG, it would appear to be more effective in reducing acute inflammation and this supports our experience with the beneficial effects of intra-articular Adequan™ after arthroscopic surgery when there is considerable cartilage loss and subchondral bone exposure, which leads to a persistent synovial inflammation.

Which sort of leads us right back to the idea that nothing is as it seems. The first article posted here indicated HA might be very short term (as compared to adequan) and whoops, here is a study indicating that might just NOT be the case. Granted we are talking IV/IM vs. IA, but if the best researchers out there are still working this out, I doubt we can speak with any more authority, so it's back to z'what works for your horse?"

Lieslot
Jul. 21, 2010, 07:55 AM
DMK & Absolut Equestrian, thank you very much for shedding some light on it all.
It's so confusing and no clear cut answer out there. Indeed what to make of Legend now, those 2 clearly contradict each other :(.
Like you say, it'll probably end up being trial & error and sadly some $'s lost in the process :(.

And like ToNFarm mentioned often even our vets aren't up to date on the latest, like for example the Pentosan IM's apparent succes and vets never even having heard of the substance, which makes it all the more complicated to discuss issues & figure out the best approach for the horse.

I didn't realize there had been issues with the compounding part of Pentosan. The product now nevertheless caught my attention, seems it's available in Australia.

DMK
Jul. 21, 2010, 08:37 AM
well it's not so much an issue with compounding pentosan, it's compounding pharmacies in general and the laws relating to compounding Rx that is either not approved in this country (pentosan) or is still covered by patent (believe it or not, this includes apple flavored bute).

But reading some of the background on pentosan - been in use for 30 years, approved for use animals an humans in Australia & Europe ... yeah, it sort of seems like there ought to be some consideration for approval work done in other countries on animal Rx (OK, for all I know there is, but clearly the law needs to be better)

Lieslot
Jul. 21, 2010, 11:47 AM
Seems it (pentosan sulfate) is FDA approved for use in humans.
http://thehealthsalon.wordpress.com/2009/04/26/arthritis-treatment-without-the-side-effects-pentosan-sulfate/

Now considering it's not FDA approved for use in horses, are we as owners not allowed to order it directly from Australia and administer ourselves? Would that be illegal?
http://www.horsemedsonline.com/pentosan-equine-injection-100ml-p-59.html