This important study looked at the effectiveness of ertugliflozin, an SGLT2 inhibitor in reducing the high levels of insulin and the severity of lameness in 51 horses and ponies with Equine Metabolic Syndrome (EMS). It was conducted in Western Australia, and the lead author was Dr Tania Sundra. Others have shown that high levels of insulin are a major risk factor for the development of laminitis. Consequently, drugs that can lower insulin are potentially very useful in reducing the severity and risk of laminitis.
After 30 days of treatment with with oral ertugliflozin at 0.05 mg/kg once daily, there was a significant reduction in insulin concentrations from a median of >300 μu/ml to 43 μu/ml. Modified Obel laminitis scores also significantly improved, reducing from a median of 10/12 to 1/12.
This response is tremendous and is a game-changer in the management of affected ponies and horses.
The authors did report some potentially important side-effects, including increases in the serum triglyceride concentration from 0.6 before treatment to 1.4 mmol/L after 30 days of treatment, before declining. Interestingly, none of the animals developed any classical clinical signs of hyperlipaemia, including evidence of hepatic lipidosis. Ten horses (19%) were reported to have polyuria and polydipsia during treatment, otherwise no adverse clinical effects were identified.
Given this side effect the authors suggested that taking a serum biochemistry before treatment and after 7 and 30 days would be prudent in order to prevent any adverse consequences of therapy.
Conclusion: Ertugliflozin may be effective in reducing insulin concentrations in horses and ponies with equine metabolic syndrome and its use may hasten recovery from laminitis associated with hyperinsulinaemia.
This is an open access article in Equine veterinary education
