Misoprostol for the treatment of equine gastric ulcers

Though the work is early, misoprostol looks promising as a better treatment than our current drug regimens, a quick look at dose and available generic products does come to about 8$ US a day using DrugRx coupons at some of the more economical pharmacies.
DrO

Equine Vet J. 2019 Sep;51(5):575-580. doi: 10.1111/evj.13087. Epub 2019 Mar 21.
Misoprostol is superior to combined omeprazole-sucralfate for the treatment of equine gastric glandular disease.
Varley G1, Bowen IM2, Habershon-Butcher JL3, Nicholls V4, Hallowell GD2.
Author information
1 Gibbs Marsh Equine, Dorset, UK.
2 School of Veterinary Medicine and Science, University of Nottingham, Loughborough, UK.
3 British Horseracing Authority Ltd, London, UK.
4 School of Veterinary Science, University of Liverpool, Leahurst, UK.
Abstract
BACKGROUND:
Previous studies have demonstrated a poor response to healing of gastric glandular lesions with oral omeprazole and other medications.

OBJECTIVES:
To evaluate the efficacy of two novel treatments (misoprostol [M] and combined omeprazole-sucralfate [OS]) in horses for gastric glandular disease.

STUDY DESIGN:
Prospective, clinical study.

METHODS:
Sixty-three sports horses with grade >1/4 glandular disease were identified by gastroscopy. Horses received either 5 μg/kg of misoprostol per os BID 1 h prior to feeding or a combination of 4 mg/kg enteric coated omeprazole per os SID and 12 mg/kg sucralfate per os BID where drugs were given 1 h prior to feeding and sucralfate given 60 min after omeprazole; allocation was dependent upon centre. Gastroscopy was repeated at 28-35 days. Evaluators of the gastroscopy images were blinded to the treatments the horses received and images were reviewed independently.

RESULTS:
The most common presenting sign in both treatment groups was poor performance (Overall – 65.1%; M – 60.5% and OS – 75%). Overall healing (P<0.001; OR = 11 [2.8-45]) and improvement (P = 0.006; OR = 11 [1.9-59]) of lesions were associated with resolution of clinical signs. Misoprostol was shown to be superior to combined omeprazole-sucralfate both for healing (M - 72% [95% CI 43-67] and OS - 20% [95% CI 7-41]; P<0.001) and improvement (M - 98% [95% CI 90-100] and OS - 65% [95% CI 43-83]; P<0.001).

MAIN LIMITATIONS:
Relatively small, clinical study, reliance on client questionnaire data, clients not blinded to the treatments the horse received, diet could have affected drug pharmacodynamics although mimics clinical practice and no validated scoring system available for glandular lesions.

CONCLUSIONS:
These results suggest that gastric glandular disease does indeed result in clinical signs. In this population of horses, misoprostol was superior to omeprazole and sucralfate and warrants further evaluation in a large scale, multi-centre trial.