Adequan v Legend v Pentostan v Cosequin? Oral v IM?

[Lord_Helpus]

I am new to this field and I want to make sure I understand my options. I have done a search, but the main thread I could find is from 2011. Things change fast, so I thought I would ask. If there are recent threads on this topic, please feel free to refer me, instead of duplicating information.

Petey is now lame on LH. [Goobs is also lame on LH :dead: ]. The vet is pretty sure it is his hock, so he suggested Adequan. I want to be sure it really is his hock, so we are doing DMSO and HA 2x/day for 2 weeks — applied by a dauber to the inside of his hock. If this really does help after 2 weeks, then I guess we move on to a joint supplement.

Does this seem like a reasonable way to do things?

Then we get to the oral v injectable. The latter seems to be much more efficient (?). Is the ability to give an IM injection the determining factor? I can do it, if IM is the best way to go.

How much does price enter into your decision?

I gather that Legend is so much more expensive than Adequan that it is rarely prescribed anymore. True? And, what are the current thoughts of Adequan v. Pentostan? Or is Cosequin strong enough to be a viable option?

I want to choose the best option for my boy.

PS: Petey recently has become very sensitive to having his hind legs picked up. Abd, when he does allow it, he fights it after c. 20 seconds. He jerk-jerk-jerks his leg and once the human lets go, the leg sort of flies away in a jerky movement, as he sets it down. The vet said it reminded him of a horse with shivers. I need to research that; I am totally clueless about shivers.

As always, TIA

[Obsidian_Fire]

Legend didn’t do a darn thing for my old guy. And was expensive, and IV, which I could not do myself. Meaning another trip to the vet!!! $$$$.

I don’t think feed-thru’s are worth the money, altho years back Horse Journal did some studies and found that liquid HA (specifically Conquer, at that time) in oral form, worked really well. I used it, felt I got decent results from it, but nothing beats an injectable.

Have never used Pentosan and don’t know anybody who has.

People love Adequan but I never used it on my old guy so I don’t know.

[Palm_Beach]

Wow, a battle to end all battles! I always did Legend and Adequan with my race horses, IM, but my vet is switching over to Pentosan and ditching the Adequan (I think).

[Guilherme]

Never used Legend. Used Adequan many times with good results. Tried Pentosan and it was OK. Tried Previcoxx and it was not effective.

Cosequin, as an oral medication, is not as effective as an injectable. I’ve worked with one of the vets that was involved in the Cosequin study at Auburn. He says it was an honest test and Cosequin demonstrated positive results. No other oral joint supplement, to my knowledge, has a true, double-blind study behind it.

If you stay with the stuff that has real science behind it you have multiple choices. That’s good as not every medication works the same with every horse. The stuff of the shelf at the feed store, tack store, or co-op? Usually backed up by a slick ad campaign and anecdotal stories of dubious provenance.

Good luck as you go forward.

G.

[Simkie]

With regard to the hock, wouldn’t blocking the joint be a better way to see if that’s the problem?

If the hocks are ouchy, I’d rather inject the joint and then support with one of the injectible joint juice meds vs starting with the systemic stuff. Just seems to be a quicker, more effective way to get the horse comfortable.

[Horseman15]

I leased a horse with stifle and hock issues. I gave her hyaluronic acid injections and put her on Pentosan injections (6 ml twice monthly). She did really well with that.

I have one now with arthritis. The Pentosan (1 - 6ml shot monthly) has worked wonders!

Both of them were/are on the Smartpak Ultra Pellets supplements

[BoyleHeightsKid]

Another vote for injectables such as Adequan or Pentosan. My gelding responds well to both and IMO you’re getting more bang for your buck.

You could also inject the hocks. It’s invasive but that’s the biggest bang for your buck.

I don’t have much faith in feed throughs. First the horse has to eat, digest, metabolize for it to get to where it needs to go so that it might work. Plus Cosequin is $$$ and if you were to add your cost for daily supplementation of that, I’m sure it would be more expensive than the injectable or joint injections.

[MysticOakRanch]

I would do hock injections, THEN follow up with support injections. You may have to experiment, what works for one horse, may not work for another. I also agree, oral supplements are fairly useless for this specific issue.

I had one horse that we tried Adequan and Legend on with no luck at all. Then we tried Polyglycan and it was immediate improvement. Stuck with that for quite a while, then had some problems getting it, so the vet suggested we try PentAussie (which is no longer available, but Pentosan IS available, and I moved to that), and that was even better then Polyglycan for that horse.

I currently have 2 horses that I"m riding, and both have their hocks injected, and one gets Pentosan every 2 to 3 weeks. I’ve tried several orals over the year, and felt NO difference at all. But I can sure tell when I let her slide more the 3 weeks on the Pentosan…

[BoyleHeightsKid]

@Lord Helpus

PS: Petey recently has become very sensitive to having his hind legs picked up. Abd, when he does allow it, he fights it after c. 20 seconds. He jerk-jerk-jerks his leg and once the human lets go, the leg sort of flies away in a jerky movement, as he sets it down. The vet said it reminded him of a horse with shivers. I need to research that; I am totally clueless about shivers.

As always, TIA

That does sound like Shivers. A friend had a Hanovarian gelding who did this exact thing and she found regular chiro helped him a lot.

[mydogs]

If money was not an option, here is the order of treatment I would do:

1. IA injection - vet
2. IV Injection
3. IM Injection
4. Daily Supplement

Realistically, I do the following:

1. Daily supplement
2. IM Injection
3. IV Injection
4. IA Injection

I do a daily supplement and work with HorseTech to get the exact amounts of ingredients that I want. It has also allowed me to reduce the time I spend daily making supplement bags for the barn.

I tried Pentosan because it was affordable. I think almost $10-$15 per injection.

Then I gave Legend a try but it was not cheap at $80-$100/injection. I submit the manufacturer rebates for each injection to help save money. My trainer has worked with a vet before so she gives the injection. If I had to pay my vet to give an IV injection, I would probably not give Legend and either do Adequan or just go to the IA injection.

I have tried topical creams too - Surpass and CetylM cream.

When none of that worked, I did the IA injection. This made the biggest impact for my horse and does for most horses.

Now that I know what works and does not work for my current horse, I can plan properly for the future. While I wish I had done the IA injection sooner, I would have also spend a ridiculous amount of time wondering if something cheaper would have worked too, because that’s who I am. I covered all of my basis and feel better about it, financially.

I think daily supplements do best to prevent future problems and injections do better to help current problems.

For horses with minor joint issues, I think a daily supplement may be good enough.
But for horses with some major joint issues, an injection will provide the biggest difference in comfort.

For future horses, I would probably follow the same steps too.

[flyingchange]

Well, I put my 22 year old on Cosequin ASU Plus about three weeks ago. I have always been skeptical of feed throughs and so went into this with very low expectations. It could just be the placebo effect, but I will tell you that after about a week of being on that supplement, this horse was moving a heck of a lot better. He has arthritis in his hocks as well. He has gone from being a bit behind the leg in the trot to very very forward, which tells me he is feeling better. It is expensive stuff - but if he keeps moving/acting this way, then I’ll keep him on it. I used Adequan on him, as well as Legend, back when we were competing and honestly, I never felt like the Adequan did anything for him. Jury’s still out on the Legend. Hock injections - yes, they always worked wonders. But I’m trying to avoid those at this stage in his life.

[Lord_Helpus]

@Simkie

With regard to the hock, wouldn’t blocking the joint be a better way to see if that’s the problem?

If the hocks are ouchy, I’d rather inject the joint and then support with one of the injectible joint juice meds vs starting with the systemic stuff. Just seems to be a quicker, more effective way to get the horse comfortable.

I wanted to make sure that the hock is really the problem. This 2 week ‘trial’ of doing the DMSO and HA will give us a better idea if we have found the culprit. I do not expect him to go 100% sound with the DMSO and HA. But if he can canter and not swap leads behind, we start the full course of treatment.

It sounds like the majority think Adequan is the best. It is what my vet suggested, so if I go that way I do not have to disagree with him. Always a bonus.

[Lord_Helpus]

@Simkie

With regard to the hock, wouldn’t blocking the joint be a better way to see if that’s the problem?

If the hocks are ouchy, I’d rather inject the joint and then support with one of the injectible joint juice meds vs starting with the systemic stuff. Just seems to be a quicker, more effective way to get the horse comfortable.

I wanted to make sure that the hock is really the problem. This 2 week ‘trial’ of doing the DMSO and HA will help to narrow down the problem to the

[Simkie]

@Lord Helpus

I wanted to make sure that the hock is really the problem. This 2 week ‘trial’ of doing the DMSO and HA will give us a better idea if we have found the culprit. I do not expect him to go 100% sound with the DMSO and HA. But if he can canter and not swap leads behind, we start the full course of treatment.

I don’t think that painting with DMSO and HA is a recognized and accepted diagnostic test, or something that is proven to produce pain relief for a joint problem. DMSO and and a anti-inflammatory, maybe could work like that? But blocking the joint is the gold standard for identifying what hurts. DMSO and HA is a curious combination.

[Escapetotjestars]

I did a series of 7 Adequan for my mare with hock issues. I did not get a huge response from it. I don’t like doing steroid injections because she has horrible ulcer reactions to the joint injections. I now have her on a loading dose of compounded Pentosan from Wedgewood pharmacy. I see a huge difference in her. My gelding has had OCD surgery and I did a 7 series of Adequan after his surgery and now have him on Pentosan as well. I liked PentAussie but it’s not available here anymore and I also like Pentosan EQ but that’s been back ordered for about a year. My vet and I have only found the compounded Pentosan but it seems to be effective.

[horseygurl182]

As other posters said, oral supplements would be at the bottom, only because you cannot guarantee they will be 100% consumed. They’re a great add on option to injections, but should not be the main source of a maintenance plan. For example, my guy gets oral supplements (mainly Vitamin E) and will merrily swish his nose through his bucket and toss half on the floor. ​

Adequan and Legend perform two different functions and are not one and the same, however I have found IME, that Legend is much more effective when it works together with Adequan.

I have added into my horses program (due to neck arthritis and wanting to keep him comfortable) the loading dose of Adequan ($300 upfront) and then a monthly shot ($50 a month). The loading dose lasts for about 6 months. I also just re-added in Legend (I went through Allivet to order and between the $5 coupon and then the $50 rebate from the manufacturer I will end up paying $316 for a 20ml vial which has 5 doses in it). This is the cheapest I have found anywhere, and shipping was free. We also get neck injections every 6 months as well. The neck injections cost about $800 every 6 months (both sides, C5 - C7 and sedation).

If you have the funds, I would explore the injections, followed up with Adequan (loading dose) and then maintenance as needed. When you break out the cost of these items by month, it nets out cheaper than supplements and are more effective. Even if you add in a monthly shot of Legend, you still will be well under what supplements can run you and you’ll rest easier knowing your horse received it all.

Also, Adequan is done IM, which most everyone can give so you don’t need a vet call for those. Legend is IV, so the cost will go up a little if you don’t have someone readily available that can give IV. I am very lucky in that all 3 trainers at my farm can give IV, so I don’t have to pay someone to come out each time.

In addition to all of that, I also get him weekly acupuncture sessions and monthly PEMF sessions which also help a lot and keep him happy and loose. I also incorporate laser treatments since we have one available to us.

We have a horse in our barn that has Shivers. Much like yours, he hates picking up his feet and when he comes out of his stall he’ll really stretch and shake out his back legs. Other than that, he’s a normal horse and competes at top level still. He gets acupuncture - probably bi-weekly, Adequan (loading dose) and lasered every now and again. Other than that, he gets no oral supplements and isn’t any danger to himself or his rider/handlers. He’s had the condition for years and it’s super manageable.

[IPEsq]

Is Petey sore around his SI? I’d identify the body part (SI, hocks, stifles, whatever it is) first then decide on meds. But in general I would pick injectables over the feed through supplements.

[Kottbulle]

I have used the Actiflexx 4000 feed thru for years now and while it may not be strong enough to fix a serious arthritis problem, it definitely makes my senior horse feel and move better. Its also economical for me to feed 5 horses on a daily basis. I have seen amazing results with direct injections on my older gelding knees when he as getting quite sore. So if you know where the problem is specifically then that is a worth while option.
I have started my 11 yr old OTTB and my 25 yr old DWB on Pentosan and while I haven’t seen mind blowing improvements with the 11yr old, he doesn’t seem worse for it. But i have seen huge improvements in the 25 yr old gelding. He moves better, and has a much easier time with the farrier. To the point that the farrier thanked me for having him all muted up for the visit. When I told him it was just the Pentosan he said to keep him on it. i also like that it is more economical than some of the other injectables allowing me to do more horses on a budget.

[beau159]

@Lord Helpus

Petey is now lame on LH. [Goobs is also lame on LH :dead: ]. The vet is pretty sure it is his hock, so he suggested Adequan. I want to be sure it really is his hock, so we are doing DMSO and HA 2x/day for 2 weeks — applied by a dauber to the inside of his hock.

if he can canter and not swap leads behind, we start the full course of treatment.

Petey recently has become very sensitive to having his hind legs picked up.

I’m really confused.

What did your vet do?
Flexions?
Nerve blocking?
X-rays of the hock?

If your vet did not do nerve blocking or x-rays, you need to start there. If you don’t know what the problem is, then you don’t know what treatment might work.

Also, I don’t think applying DMSO and HA to the outside of the hock will do anything for whatever is going on inside the hock. There’s a reason that joints have capsules – so that external things cannot get in.

@Lord Helpus

Then we get to the oral v injectable. The latter seems to be much more efficient (?). Is the ability to give an IM injection the determining factor? I can do it, if IM is the best way to go.

I will always choose IM over oral.

An oral feed-through has to first pass through the digestive system, before getting to the joints. Therefore not much makes it to the joints.

IM does not have to pass through the digestive tract.

@Lord Helpus

I gather that Legend is so much more expensive than Adequan that it is rarely prescribed anymore. True? And, what are the current thoughts of Adequan v. Pentostan? Or is Cosequin strong enough to be a viable option?

Legend and Adequan are different medications and have different results.

Legend is more “fast acting” and really only gives you a benefit for roughly 48 hours or so. People will often go Legend right before a big show or event.

Adequan helps for a little more longer term. There is also controversy on whether two loading doses should be used per year (as recommended by the manufature) versus doing a loading dose followed by once a month dose after that. Some people might argue the “research” says that two loading doses is better, but those people haven’t actually taken the time to read the research (because the research did not prove that, and wasn’t even studied). HOwever, the horse will still get benefit no matter how your vet instructs you to use it.

Pentosan is a less expensive option. It is a similar medication to Adequan.

In my opinion, Cosequin can’t be compared to Legend, Adequan, or pentosan.

So getting back to it … WHAT DID YOU VET DIAGNOSE YOUR HORSE WITH?
Arthritis?
Fusing hocks?
Bone spur?
Soft tissue problem?
If your horse doesn’t have a diagnosis, it’s impossible to know what “treatment” is going to help.

But I will add that steroid injections into the hock are very effective for arthritis soreness. Along with PRP, IRAP, or ProStride joint injections.

[ndirish07]

It sounds like the first step is confirming what your vet did in terms of diagnostics and what the horse was diagnosed with or what the differential diagnosis is? I just had a pro-active vetting and wanted my vet to check out a sticky stifle–come to find out my issues were actually related to a front foot. We’re talking very minor lameness only visible on a 10m circle, and on hard ground, but it’s there and it’s enough that my delicate hot house flower reacts to it when jumping and does all sorts of weird things contorting his body to avoid it.

To your specific question, my preference is to inject the troubled joint first and then do some type of injectable either IM or IV. I don’t think oral supplements are all that fantastic as there’s no real conclusive evidence they work (cosequin being the exception). I think it’s a good complement to an injectable schedule. So in addition to some shoeing changes, I’m currently doing a dose of Adequan. My vet prefers the twice yearly loading dose. I have one more shot to do and can already tell a big change in how he feels.

My horse is on a pretty aggressive joint health regime, by my choice: Adequan, 2x a year; Legend before events; and an oral joint supplement; hock injections as needed.