Efficacy of pergolide for the management of Equine Cushings (PPID)

Though not as good as a double blinded study this review of 28 publications selected out of over 600 for quality were quite sure: “in the vast majority of the included studies, pergolide was reported to provide overall clinical improvement in >75% of cases”. The effects on particular clinical signs and the improvement in lab values varied also but were impressive: “A reduction in plasma ACTH concentrations was reported in 44-74% of cases, while normalization to within reported reference intervals occurred in 28-74% of cases.”

I would be remiss to not mention my wife’s older Paso Fino, diagnosed as PPID by clinical signs and labs, showed clinical improvement in muscle along his topline and exercise tolerance within one month of starting treatment. Cost (veterinary wholesale): appx 1.60 / day for Prescend®
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Efficacy of pergolide for the management of equine pituitary pars intermedia dysfunction: A systematic review
Vet J. 2020 Dec;266:105562.
Authors
R C Tatum 1 , C M McGowan 2 , J L Ireland 3
Affiliations

1 Institute of Aging and Chronic Disease, Faculty of Health and Life Sciences, The University of Liverpool, Leahurst Campus, Neston, Cheshire CH64 7TE, UK.
2 Institute of Aging and Chronic Disease, Faculty of Health and Life Sciences, The University of Liverpool, Leahurst Campus, Neston, Cheshire CH64 7TE, UK; Institute of Veterinary Science, Faculty of Health and Life Sciences, The University of Liverpool, Leahurst Campus, Neston, Cheshire CH64 7TE, UK.
3 Institute of Aging and Chronic Disease, Faculty of Health and Life Sciences, The University of Liverpool, Leahurst Campus, Neston, Cheshire CH64 7TE, UK; Institute of Veterinary Science, Faculty of Health and Life Sciences, The University of Liverpool, Leahurst Campus, Neston, Cheshire CH64 7TE, UK. Electronic address: Joanne.Ireland@liverpool.ac.uk.

PMID: 33323174
DOI: 10.1016/j.tvjl.2020.105562

Abstract

Pergolide, a dopamine agonist, is commonly administered to manage pituitary pars intermedia dysfunction (PPID), a progressive neurodegenerative disease prevalent in aged horses. However, available evidence regarding pergolide’s efficacy in improving clinical and endocrine parameters is limited. The aim of this systematic review was to assess published literature and evaluate evidence regarding whether pergolide treatment results in improvement of clinical signs and/or adrenocorticotrophic hormone (ACTH) concentration compared to no treatment or other unlicensed treatments. Systematic searches of electronic databases were undertaken in April 2019, repeated in August and October 2019, and updated in July 2020. English language publications published prior to these dates were included. Screening, data extraction and quality assessment of publications was undertaken individually by the authors using predefined criteria and subsequently cross-checked. Modified critically appraised topic data collection forms were used to extract data. Due to marked between-study variations, meta-analysis was not undertaken. After removal of duplicate records; 612 publications were identified, of which 129 abstracts were screened for eligibility and 28 publications met criteria for inclusion in the review. Most studies were descriptive case series, cohort studies or non-randomised, uncontrolled field trials. Despite marked variation in study populations, case selection, diagnostic protocols, pergolide dose, follow-up period and outcome measures, in the vast majority of the included studies, pergolide was reported to provide overall clinical improvement in >75% of cases. However, reported improvements in individual clinical signs varied widely. A reduction in plasma ACTH concentrations was reported in 44-74% of cases, while normalisation to within reported reference intervals occurred in 28-74% of cases.