1. What is Cushing’s?
Equine Cushing’s disease, also known as pituitary pars intermedia dysfunction (PPID), is probably the most common disease of geriatric horses. Affected horses show a variety of clinical signs, including excessive hair growth with reduced to no seasonal shedding, frequent urination and drinking, suppression of the immune system, muscle wasting, and founder.
2. What is pergolide?
Pergolide is the most common medication used for the treatment of Cushing’s disease/PPID and is a prohibited substance under USEF Equine Drugs and Medications Rules.
3. What is a pergolide Therapeutic Use Exemption (TUE)?
This is an exemption for the use of pergolide in those competition horses with documented disease.
4. Does this mean that pergolide is a permitted medication?
No, pergolide will continue to be a prohibited substance under USEF Equine Drugs and Medications Rules, but the TUE process will permit the continuous treatment of Cushing’s disease/PPID in competition horses documented with the disease.
5. Does the TUE process apply for Fédération Équestre Internationale (FEI) competitions?
No, pergolide is considered a prohibited substance under FEI rules and is not permitted in competition, and no exemption or form applies.
6. How does this differ from a Medication Report Form (MRF)?
The use of an MRF requires the withdrawal of a horse from competition for 24 hours following the last administration of a prohibited substance. A TUE will permit the horse to compete without having to observe a 24-hour withdrawal from pergolide. Trainers will still be able to utilize MRFs to document the administration of pergolide but would be required to file an MRF in accordance with GR411 prior to each time the horse competed.
7. How do I apply for a TUE for pergolide?
The process can be initiated with the filing of an electronic MRF for pergolide. Just complete the online MRF and check the box that says "I would like to be considered for a Pergolide Therapeutic Use Exemption", and the process will start. Once the request for consideration is received, an email will be sent with a request for more information from the treating veterinarian.
8. How long will a pergolide TUE be effective, and is it necessary to reapply?
A pergolide TUE will be effective for three years from the approval date. Prior to the TUE’s expiration, a request can be made to extend the effective period for an additional three years.
9. How does this change the way my horse with Cushing’s/PPID needs to be medicated with pergolide?
If your horse is granted a TUE based upon documented medical tests and clinical history, there will be no need to file MRFs at each competition or to change the frequency or schedule of their pergolide treatment.
10. What kind of information does my veterinarian need to provide for my horse to be granted a pergolide TUE?
The treating veterinarian should provide a history of the horse’s clinical signs and any diagnostic tests that have been completed. This information will be submitted by the veterinarian, along with any documents, including diagnostic tests and case notes, which can be uploaded as part of the application.
11. How long will it take to be notified about my request for a TUE?
Once the application is complete, and all supporting information has been submitted, the process may take between one and four weeks. Once the application is reviewed, your veterinarian may be contacted for follow up information prior to a decision.
12. Can a TUE be used for other treatments?
No, the use of a TUE can only be requested for pergolide at this time. The USEF recognizes the benefit of this medication in the treatment of Cushing’s/PPID-affected horses to normalize the endocrine feedback mechanisms disrupted by this disease.