Bramlage: Decreased Use of Depo-Medrol a Plus

Respected equine surgeon Dr. Larry Bramlage believes reduced use of a specific corticosteroid has contributed to the reduction in catastrophic breakdowns.

During a panel discussion on lameness at the Welfare and Safety of the Racehorse Summit June 28 at Keeneland, Bramlage said he believes one of the biggest factors in reduced catastrophic breakdowns is less use of the corticosteroid Depo-Medrol (methylprednisolone acetate).

Earlier in the day, Dr. Tim Parkin, senior lecturer at the University of Glasgow in Scotland and Equine Injury Database analyst, said the rate of catastrophic breakdowns fell from 1.89 per 1,000 starts to 1.62 per 1,000 from 2014 to 2015. The rate was the lowest in the seven years the information has been collected, and down 19% from 2.0 in 2009.

Bramlage, surgeon at Rood & Riddle Equine Hospital, said improved regulation and reduced use of corticosteroids across the board has helped, but he believes reduced use of Depo-Medrol is a key factor in the improved safety numbers. Bramlage said Depo-Medrol stays in a horse's system for so long that if a horse was injected frequently, it was possible the previous dose was still in the horse's system when the next dose was administered.

At the 2012 summit, Dr. Wayne McIlwraith said Depo-Medrol reduces lameness but also causes a significant increase in cartilage degradation. He said the same problem wasn't found in other products such as Vetalog (triamcinolone acetonide) and Celestone Soluspan (betamethasone sodium phosphate and betamethasone acetate).

"Depo-Medrol is bad; the others are good. That's the bottom line," McIlwraith said at the time.

The National Uniform Medication Program includes Depo-Medrol on its list of therapeutic medications but the corticosteroid carries a 21-day withdrawal time, limiting its use in racing.

Bramlage and panel member Dr. Mary Scollay, equine medical director for the Kentucky Horse Racing Commission, said improved corticosteroid regulation has helped. Scollay said incidents of stacking—administering multiple corticosteroids—has been reduced, while Bramlage said veterinarians have realized that limited use of corticosteroids is a better approach.

Scollay said the improving approach of corticosteroid use has not only helped improve the pre-race assessments of horses by regulatory vets, it has helped trainers more readily see the underlying problems causing lameness.

"Trainers aren't entering horses that aren't right because they've had an opportunity to look at that horse and tell that they're not able to run," Scollay said.

As for lameness issues, Bramlage noted that open CT scans promise to be an important tool for vets but said it will take some time to adjust to the new information.

"Standing CT will be another step forward," Bramlage said. "The trouble is you'll find so many things, that you have to learn what is a problem and what is not. It will take understanding, research, and experience to put what you're seeing in perspective."

Bramlage said he's impressed with the strides made by regulatory vets.

"Regulatory veterinarian is now a profession," Bramlage said. "There was a time when odds were it was a small animal vet spending his retirement at the races. That's no longer the case. It has changed a lot."