A molasses-flavoured pergolide paste that can be given in small doses (less than 0.5 mg) has been tested and although not yet licensed may be available in the UK through a horse's vet.

David Rendle presented his research Efficacy of a novel palatable pergolide paste formulation for the treatment of PPID in ponies at the BEVA conference in September 2018.  Rendle suggested that the only form of pergolide currently licensed for horses in the UK, Prascend, is not always eaten readily and can be difficult to split and administer below half a tablet.  A molasses-flavoured pergolide paste from BOVA UK that can be given in small doses was given to 19 ponies who had not responded well to Prascend, and their clinical records reviewed.  They were considered to have PPID if their ACTH concentration was >50 pg/ml in July or >100 pg/ml from August to October.  All the ponies were examined after 1 and 6 months of treatment and doses adjusted if necessary according to season.  ACTH concentrations improved significantly and returned to normal in 74% of the ponies, clinical signs showed some improvement but some clinical signs either did not improve or became worse.  1 pony refused to eat the paste and 2 ponies went off their feed but this resolved when the dose was reduced.

The BOVA pergolide paste is currently not licensed, but may be used through the medicines cascade if Prascend (currently the only licensed form of pergolide) cannot be used (e.g. because it does not appear to be effective or causes significant side effects).  The paste is available to horses in the UK through their vet.  It may be possible to export to other countries if a vet in that country is prepared to import it (it cannot be distributed to anyone other than a vet).

Rendle DI, Frost R, Byrne A
Efficacy of a novel palatable pergolide paste formulation for the treatment of pituitary pars intermedia dysfunction (PPID) in ponies
EVJ Sept 2018 Vol 50, Issue S52 Clinical Research Abstracts of the BEVA Congress September 2018 P 12-13
https://doi.org/10.1111/evj.16_13008

Palatable pergolide paste for PPID: BEVA award for Rendle presentation on clinical research into new treatment option for "equine cushings disease" - The Hoof Blog Fran Jurga November 2018 
​

National Equine Health Survey (NEHS) 2018

The National Equine Health Survey (NEHS) 2018 received information for over 13,000 horses, giving a snapshot of the health of UK horses for one week in May 2018.
38% of horses had one or more health problems recorded.
Of all the disease syndromes recorded, 29% were lameness including laminitis (23% in 2017), and 7.4% were metabolic diseases (8.1% in 2017).
Laminitis made up 5.4% of all individual disease syndromes recorded (6.5% in 2017), and PPID 5.3% (6.0% in 2017).  43% of laminitis cases were first episodes and 57% were repeat episodes (49% and 51% respectively in 2017). 

However, without knowing how many individual syndromes were reported, these figures are not particularly helpful.  All we know from the report is that 38% of 13,873 horses, so 5,272 horses, had 1 syndrome or more.
So a minimum of 2% of the population had laminitis when the survey ran for a week in May 2018 (calculated 38% of 13,873 horses = 5,272 x 5.4% = 285 / 13.873 = 2%).
Similarly a minimum of 2% had PPID, and 2.8% had metabolic diseases - but does metabolic disease include PPID, or does it mean EMS?  How many had EMS AND PPID, and how many had PPID without EMS?

67% of horses were recorded as having a body (fat) score of 3 with 17.8% recorded as being thin (score of 2 and under) and 15.5% recorded as overweight (greater than 3). [However, previous research has suggested that owners tend to under-estimate their horses' body condition scores].

According to this article from Kentucky Equine Staff
Can Body Shape Predict Metabolic Issues in Horses? KER August 2018
reporting on research by Fitzgerald et al. at Queensland University presented at the 2018 Australasian Equine Science Symposium:
Fitzgerald DM, Sillence MN, De Laat MA
Morphometric measurements for identifying equine metabolic syndrome.
Proc. Australasian Equine Science Symposium 2018 7:29
cresty neck score (CNS), but not body condition score (BCS), neck or girth circumference, was positively correlated to a post oral glucose test insulin result that suggested Equine Metabolic Syndrome.

However, 
Coleman MC, Belknap JK, Eades SC, Galantino-Homer HL, Hunt RJ, Geor RJ, McCue ME, McIlwraith CW, Moore RM, Peroni JF, Townsend HG, White NA, Cummings KJ, Ivanek-Miojevic R, Cohen ND
Case-control study of risk factors for pasture-and endocrinopathy-associated laminitis in North American horses
J Am Vet Med Assoc. 2018 Aug 15;253(4):470-478. doi: 10.2460/javma.253.4.470
looked at 199 horses diagnosed with endocrinopathic laminitis after grazing and found that "horses with an obese body condition (i.e. body condition score ≥ 7), generalized or regional adiposity (alone or in combination), preexisting endocrinopathy, or recent (within 30 days) glucocorticoid administration had increased odds of developing PEAL, compared with horses that did not have these findings."

​We are now well into the seasonal rise (in pituitary hormones) in the northern hemisphere.
In the UK the seasonal rise is thought to start around the end of June/start of July, peak in September, with hormones returning to normal around the end of November/start of December.

Three important facts about the seasonal rise:

1. Horses with PPID may need an increase in their pergolide dose during the seasonal rise. Testing resting ACTH in August may help to identify horses that need an increased dose.

2. For horses suspected of having, but not yet diagnosed with PPID, testing resting ACTH in September may be the best time to differentiate horses with PPID from normal horses. Lab fees for ACTH testing are currently free for horses (in the UK) that haven't been diagnosed with PPID through Talk About Laminitis.

3. Horses with PPID may show increased clinical signs of PPID during the seasonal rise. Horses that have unexplained laminitis or infections, particularly from August to October, may need to have PPID eliminated as a contributing factor.

In all cases, if you are worried that your horse may have PPID or needs a change in his/her treatment, speak to your vet.

​(Graph: used with permission from Liphook Equine Hospital)

The autumn seasonal rise is now thought likely to be the best time of year to test resting ACTH for the diagnosis of PPID, but how are blood test results interpreted during this time?
Liphook Equine Hospital is at the forefront of research in this area, having initially suggested that a two-tier reference interval should be used, with a cut-off of 47 pg/ml from August to October, and a cut-off of 29 pg/ml the rest of the year.

However, this was still a rather crude measure, not allowing for the gradual increase and decrease in ACTH through the seasonal rise, and new weekly cutoff values are now being used at Liphook, based on the ACTH results of over 35,000 horses, with ACTH concentrations increasing shortly after the June solstice (when day length starts to decrease), peaking around the September equinox, and declining back to basal levels by the end of November.

Interestingly, Liphook found that insulin and glucose concentrations did not appear to increase alongside ACTH, and if anything insulin and glucose tended to be higher from December to March.
What isn't clear from these new cutoffs though is how the transitional zone around them should be interpreted, as research by David Rendle et al published in 2013 suggested "Our results support previous assertions that ACTH is a reliable means of differentiating non-PPID and PPID horses but indicate that there is a transitional zone, around currently recommended cut-offs for diagnosing the disease, at which further testing should be considered."
Rendle DI, Litchfield E, Heller J, Hughes K J
Investigation of rhythms of secretion and repeatability of plasma adrenocorticotropic hormone concentrations in healthy horses and horses with pituitary pars intermedia dysfunction
Equine Veterinary Journal Vol 46, Issue 1, pages 113–117, January 2014 (published online Aug 2013)

More information:
Seasonal Changes in ACTH Secretion - Liphook Equine Hospital

Further Observations of Seasonality of Pars Intermedia Secretory Function in 30,000 Horses and Ponies - Andy Durham - p 11-12 Dorothy Russell Havemeyer Foundation Equine Geriatric Workshop II 3rd Equine Endocrine Summit 2014

​​Herbie walking comfortably in her Sole Supports.  She had been wearing them for just over a week, with them being removed and reapplied every 2-3 days so that we could keep an eye on her feet.  ​

The Sole Supports appear to be ideal for emergency support for horses with laminitis, and a pair of soft Supports would seem a sensible addition to any laminitis first aid kit. 

Horse and pony owners in England, Scotland and Wales are encouraged to participate in research being carried out by the Animal Health Trust.

At least 3,333 horses and ponies are needed to join the Care About Laminitis study, which is taking place over 2 years, starting July 2014. These can be horses/ponies that have already had laminitis, currently have laminitis, that have EMS or PPID, or that have never had laminitis and don't appear to be at risk. Owners can enrol more than one horse.

The research aims to find out how many horses and ponies are affected by laminitis, and what factors increase/decrease the risk of a horse/pony developing laminitis, particularly focusing on management factors that owners can control. The project also wants to provide owners with guidelines to reduce the impact of laminitis.

You can register your interest in taking part in the study now, and registration will open at the end of this month. You will need to provide basic details (address, vet, hoof care professional) and give information about your horse/pony, turnout and management of grazing, stabling, feeding, exercise, transport, hoof care. health management and recent health history, and asked to record any changes every month. You'll be sent a weight tape and asked to track your horse's weight online, and if your horse does get laminitis you will be asked to report it. 

This is a great opportunity for owners to become involved in research that could help the health and welfare of their and other horses.

(Originally posted 04 July 2014, last update 07 Oct 2015)

Update September 2014
Owners who have registered with the CARE About Laminitis study are sent a booklet and tape measure with clear instructions of how to body condition score, neck crest score and calculate the weight of their horse.  These details are entered online enabling owners to track increases and decreases in their horse's weight/fat - a great incentive for those that are dieting!  

We suggest getting together with a friend to go through the measuring and recording - it's easier to be objective and it's fun - below, Claire (founder of the Facebook EMS, PPID & Laminitis UK Group) and Andrea from TLS carry out Oscar's initial assessment.

Oscar's CARE About Laminitis diary - Oct 2015
We have now had one year of religiously doing the monthly weigh-ins with Oscar for the CAL project. 
Oscar weighed in via the tape measuring and score system according to the CAL booklet at 576 kg in September 2014, giving him a BCS of 4.
At the time he was strip grazing a paddock on an ex-dairy farm livery yard and stabled during the day. Exercise during that summer was limited due to transitioning to barefoot from iron shoes, a choice made due to signs of unhealthy feet. 
December 2014 Oscar moved to an old meadow pasture and living out 24/7 with field shelter access. This came with new management strategies as the grass was very long! Strip grazing through the winter he grazed himself a track. 

Laminitis and the Feet, the second in a series of articles about laminitis written by The Laminitis Site, was published in The Arabian Magazine's May 2015 edition.  Click on the image to read the full article as published in pdf format, or click here to read an extended article on The Laminitis Site website.