Preliminary observations on the use of ertugliflozin in the management of hyperinsulinaemia and laminitis in 51 horses: A case series

BackgroundHyperinsulinaemia-associated laminitis (HAL) is encountered commonly in equine practice. There are currently no registered medications which specifically target hyperinsulinaemia in horses and ponies. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been demonstrated to limit post-prandial insulin responses and prevent the development of diet-induced laminitis. ObjectivesThe objective of the study was to evaluate the efficacy of an SGLT2i, ertugliflozin, in the management of hyperinsulinaemia and laminitis. Study designRetrospective case series. MethodsMedical records of 51 horses and ponies that had presented with laminitis and hyperinsulinaemia and had been treated with oral ertugliflozin at 0.05 mg/kg once daily for a minimum of 30 days were reviewed. ResultsAfter 30 days of treatment with ertugliflozin, there was a reduction in insulin concentrations from a median of >300 mu u/ml (IQR: 149, >300) to 43 mu u/ml (IQR: 20, 66) (p < 0.001). Modified Obel laminitis scores improved, reducing from a median of 10/12 to 1/12 (p < 0.001). Median serum triglyceride concentrations increased from 0.6 (IQR: 0.4, 0.9) before treatment to 1.4 (IQR: 0.8, 3.7) mmol/L after 30 days of treatment (p < 0.001) before declining, however, none of the horses developed any clinical signs of hyperlipaemia. Ten horses (19%) were reported to have polyuria and polydipsia during treatment, otherwise no adverse clinical effects were identified. Main limitationsThe study was limited by the absence of a control group, the retrospective data collection and the short period of follow-up. ConclusionsErtugliflozin 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.