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HISA: Furosemide Advisory Committee To Oversee Three-Year Study On Anti-Bleeding Medication

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by HISA Communications

 

The Horseracing Integrity and Safety Authority (HISA) has announced the members of an Advisory Committee which has been convened to oversee a three-year study on the use of furosemide (also known as “Lasix”) on horses during the 48-hour period before the start of a Covered Horserace, including the effect on equine health and the integrity of competition.

The establishment of this Advisory Committee for the study of furosemide administration and the requirements of the study are specifically mandated and set forth in the Horseracing Integrity and Safety Act. The HISA Board of Directors delegated its authority to select the Advisory Committee members to HISA’s Anti-Doping and Medication Control Committee who did so based on the members’ relevant expertise. The Advisory Committee will oversee the process of issuing a Request for Proposal to conduct the research, reviewing grant applications from academic researchers and allocating grant funding for the study.

When the independent scientific research has been completed and published, it will be presented to the Advisory Committee who will then relay the findings and their recommendations to the HISA Board of Directors.

The Furosemide Advisory Committee is comprised of the following members:

Dr. Emma Adam, DVM, Ph.D., is a veterinarian with over 24 years of racing experience in the United States, United Kingdom, France and Australia. She is board-certified in equine medicine from Texas A&M University and in surgery from the New Bolton Center at the University of Pennsylvania. Dr. Adam also received her Ph.D. in musculoskeletal science from the University of Kentucky’s Gluck Equine Research Center.

Alan Foreman is Chairman of the Thoroughbred Horsemen’s Association (THA) and Vice- Chairman of the Racing Medication and Testing Consortium (RMTC). Foreman is considered one of the leading racing law and equine attorneys in the United States and is an expert on medications used in horse racing.

Dr. Scott Hay, DVM, is a veterinarian at Teigland, Franklin and Brokken, where he focuses on lameness, performance evaluations and purchase examinations. He also serves on the RMTC’s Scientific Advisory Committee. Dr. Hay previously served as President of the American Association of Equine Practitioners (AAEP) and as a member of the Grayson-Jockey Club’s Scientific Advisory Committee.

Dr. Ted Hill, VMD, is a racing steward for the Jockey Club with more than 23 years of experience. He previously served as Chief Veterinarian for the New York Racing Association (NYRA). Dr. Hill received his VMD from the University of Pennsylvania.

Dr. Rob Holland, DVM, Ph.D., is a respiratory and infectious disease specialist in Lexington, Kentucky and partner at Holland Management Services, Inc., a consulting practice offering solutions in outcomes research and veterinary medicine. Dr. Holland has worked with the Kentucky Horse Racing Commission (KHRC) and is an expert in equine drug testing processes.

Dr. Heather Knych, DVM, Ph.D., DACVCP, is a Professor of Clinical Veterinary Pharmacology and Head of the Pharmacology Section at the K.L. Maddy Equine Analytical Chemistry Pharmacology Laboratory at the School of Veterinary Medicine at the University of California, Davis. Dr. Kynch is board-certified in Clinical Veterinary Pharmacology and has an extensive publication record in the areas of pharmacokinetics and pharmacodynamics. She received her DVM and Ph.D. in Pharmacology and Toxicology from the University of California, Davis, where she also conducted her residency in Veterinary Pharmacology.

Ryan Murphy is the Executive Director for the Partnership for Clean Competition (PCC), the leading anti-doping research organization dedicated to the protection of clean athletes. Prior to joining the PCC, Murphy served as Program Officer with the Sports Diplomacy division at the U.S. Department of State and prior to that as Senior Manager for Sport & Competition for Special Olympics International. Murphy has also worked as an International Doping Control Officer for International Doping Tests & Management. In addition to his work at the PCC, Murphy serves as an Adjunct Professor for the Sports Industry Management Master’s program at Georgetown University.

Dr. Foster Northrop, DVM, is a practicing racetrack veterinarian with more than 35 years of industry experience. He has served on the boards of the KHRC and American Veterinary Medical Association (AVMA), as well as the RMTC’s Scientific Advisory Committee.

Dr. Scott Palmer, VMD, is a former President of the AAEP and the American Board of Veterinary Practitioners (ABVP). He also chaired the New York Task Force for Racehorse Health and Safety from 2011 to 2013 and served as a clinician and referral surgeon at the New Jersey Equine Clinic for 38 years. He is currently a member of the RMTC’s Scientific Advisory Committee, the Horseracing Testing Laboratory Committee, the Association of Racing Commissioners International’s (ARCI) Drug Testing and Standards Committee and the ARCI’s Equine Welfare and Veterinarians Committee.

Dr. N. Edward Robinson, BVetMed, Ph.D., is a nationally recognized veterinarian, academic and researcher who spent nearly 50 years at Michigan State University’s College of Veterinary Medicine, during which he spent more than 20 years as the Matilda R. Wilson Professor of Large Animal Clinical Sciences. Dr. Robinson has spent his career researching lung disease in horses. He received his veterinary degree from the Royal Veterinary College in London and a Ph.D. from University of California, Davis.

Dr. Corinne Sweeney, DVM (HIWU Appointment), is an American College of Veterinary Internal Medicine (ACVIM) specialist and has spent the past 44 years at the University of Pennsylvania School of Veterinary Medicine. She has served as a member of the Pennsylvania State Horse Racing Commission since 2008 and previously served as Chair of the ARCI in 2019. She is a certified Organizational Ombuds Practitioner and has served as the Penn Vet Ombuds since 2015.

About the Horseracing Integrity and Safety Authority

When the Horseracing Integrity and Safety Act was signed into federal law, it charged the Horseracing Integrity and Safety Authority (HISA) with drafting and enforcing uniform safety and integrity rules in Thoroughbred racing in the U.S. Overseen by the Federal Trade Commission (FTC), HISA is implementing, for the first time, a national, uniform set of rules applicable to every Thoroughbred racing participant and racetrack facility. HISA is comprised of two programs: the Racetrack Safety Program, which went into effect on July 1, 2022, and the Anti-Doping and Medication Control (ADMC) Program, which went into effect on May 22, 2023.

The Racetrack Safety Program includes operational safety rules and national racetrack accreditation standards that seek to enhance equine welfare and minimize equine and jockey injury. The Program expands veterinary oversight, imposes surface maintenance and testing requirements, enhances jockey safety, regulates riding crop use and implements voided claim rules, among other important measures.

The ADMC Program includes a centralized testing and results management process and applies uniform penalties for violations efficiently and consistently across the United States. These rules and enforcement mechanisms are administered by an independent agency, the Horseracing Integrity and Welfare Unit (HIWU), established by Drug Free Sport International (DFS). HIWU oversees testing, educates stakeholders on the Program, accredits laboratories, investigates potential ADMC violations and prosecutes any such violations.

New Study Finds Horses Racing On Lasix At 62 Percent Increased Risk Of Sudden Death

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by Paulick Report Staff

 

A new study of data from the Equine Injury Database has revealed that horses medicated with furosemide (Lasix) on race day were at 62 percent increased odds of sudden death compared to horses that were not racing on furosemide.

Funded by the Grayson Jockey Club Foundation, the study was published by Dr. Euan Bennet and Dr. Tim Parkin on Oct. 20, 2022, in the Journal of the American Veterinary Medical Association. It examined the 4,198,073 race starts made by 284,387 Thoroughbred horses at 144 racetracks in the United States and Canada between 2009 and 2021; those numbers represent 92.2 percent of all official race starts during that period.

Of those nearly 4.2 million starts, 536 resulted in a horse’s sudden death, an incidence rate of 0.13/1,000 starts. Sudden death was defined as any horse that was recorded as a fatality within three days of racing, along with one or more of the following fatal injury descriptions or (presumptive) diagnosis, as provided by each participating track to the EID: (1) sudden death (recorded as “SUD” in the EID), (2) pulmonary hemorrhage, (3) exercise-induced pulmonary hemorrhage (EIPH), (4) postexertional distress/heatstroke (PED), and (5) cardiac arrhythmia.

 

Read Paulick Report Article

Lasix Mythbusters: Drug Masking, TCO2, And Impact On Racehorse Breakdowns

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by Natalie Voss

 

For decades now, people with an interest in horse racing have had opinions about furosemide, commonly referred to by its trade name of Lasix or Salix. Even now, as its use has been gradually pushed back farther from race time, theories abound on why trainers use it, and how (or whether) it should be used.

But floating about amongst all those opinions are sometimes misconceptions, including one we’ve heard repeatedly at the Paulick Report – that furosemide is used as a masking agent to cover up illegal drug use in post-race testing.

Dr. Rick Sams, former laboratory director at LGC Science, said that under current regulations, that just isn’t possible. Here’s why.

 

Read Paulick Report Article

Kentucky Horsemen’s Group Sues Churchill, Keeneland, Commission Over Lasix House Rules

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by

 

This week would begin the first 2-year-old races of 2020 in Kentucky, and is meant to mark the start of a partial phaseout of furosemide on race day. The Kentucky Horsemen’s Benevolent and Protective Association is hoping to put a stop to that phaseout.

The horsemen’s group filed a civil suit in Franklin County Circuit Court May 15 seeking to remove racetracks’ legal ability to card Lasix-free races, as well as requests for an emergency and a permanent restraining order and a temporary injunction to stop Churchill Downs and Keeneland from running 2-year-old races without Lasix under house rules. The suit names the Kentucky Horse Racing Commission, Keeneland Association, and Churchill Downs Inc. as respondents.

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More Than 600 Stakeholders from Across the Racing Industry Sign Public Letter In Support of Protecting Lasix as a Choice on Race-Day

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LEXINGTON, KY (Friday, Sept. 20, 2019) – A unified industry group believes banning Lasix will adversely impact the health and welfare of racehorses, as well as the strength of our industry. Today, a letter (posted below) was released with more than 600 signatures in support of protecting Lasix as a choice for horsemen and veterinarians to administer on race-day for the well-being of equine and human athletes. The initial round of signatures from racing stakeholders features individuals from across the industry. Signatures will continue to be collected going forward. Click here to be added to the list.

Public Letter on Stance to NOT Eliminate the Choice to Administer Lasix on Race Day

A recent open letter proclaimed that “horse racing is at a pivotal moment in its long history in the United States.” On this we agree. We also agree all of us love and cherish the equine athletes upon which our industry is built. To that end we believe in practicing the highest standards of horsemanship, and we continually work to improve the care, health and safety of our thoroughbred racehorses.

In that regard, we support horsemen and our veterinarians having the continued option to run a horse with a race-day administration of the therapeutic and protective medication furosemide (Lasix).

We, too, are ready for change and will eagerly embrace change if the alterations are done for the greater good of equine health and welfare. We are committed to reforms emphasizing transparency and developments that will address misunderstandings from those in the non-racing public as well as ensuring our horses are treated with the highest degree of care. The eradication of our choice to administer race-day Lasix will not do any of those things.

It is our belief that banning Lasix will adversely impact the health and welfare of our racehorses as well as the strength of our industry. Research also proves an increased number of horses will bleed significantly out of their nostrils, or into in their lungs, and an increased number will die.

We understand and agree things can and should be done to improve the safety and welfare of our equine athletes. It is just as important to understand what is NOT causing catastrophic injuries, as it is understanding the underlying causes. Many continue to claim Lasix will interfere with post-race drug testing due to dilution, but this argument has long been disproven. Lasix is a short-acting diuretic and the dilution effect is gone in two hours. However, the tightly regulated administration of Lasix is required four hours before a race. Thus, Lasix has no ability to interfere with blood or urine testing after a race.

No one takes our stance on this position casually, but we believe we must not be led down a path created by perception and not facts. For this reason we must stand for what is in the best interest and safety for our equine and human athletes.

This letter includes an initial round of over 600 signatures from racing stakeholders and signatures will continue to be collected going forward. Click here to be added to the list.

Signatures include the following: Rusty Arnold; Steve Asmussen; Buff Bradley; Bret Calhoun; Anita and James Cauley; Dr. Nancy Cole; Brad Cox; Boyd Caster; Wayne Catalano, Jake Delhomme; Michael Ann Ewing; Greg Foley; Vickie Foley; Tim Glyshaw; Larry Jones; Dallas Keen; Marshall Gramm; Dr. Chuck Kidder; Mike and Penny Lauer; Mike Maker; Ron Moquett; Randy Morse; Maggi Moss; Loren Hebel Osborne; Joe Orseno; Joel Politi; Allen Poindexter; Louis J. Roussel III; Clay Sanders; Chester Thomas; Mike Tomlinson; Tom Van Berg; Kelly Von Hemel; Gary and Mary West; Ian Wilkes; Jack Wolf; Erv Woolsey.

The entire list may be viewed as a PDF file and can also be found at this link (list updated as of 9/20/19):

Industry Reaction To Racetrack Coalition’s Proposed Partial Phase-Out Of Lasix

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by

 

Reaction was mixed to the announcement on Thursday by a coalition of U.S. racetracks to partially phase out race-day administration of the anti-bleeding diuretic furosemide (Lasix), beginning with 2-year-olds racing in 2020 and in stakes races beginning in 2021.

Those supporting the initiative include all tracks owned or operated by Churchill Downs Incorporated (CDI), the New York Racing Association, Inc. (NYRA) and The Stronach Group as well as Del Mar, Keeneland, Lone Star Park and Remington Park, Los Alamitos Racecourse (Thoroughbreds), Oaklawn Park and Tampa Bay Downs. Breeders’ Cup Limited, the Thoroughbred Owners and Breeders’ Association (TOBA) and its American Graded Stakes Committee and the Kentucky Thoroughbred Association also signed on in support of the proposal.

 

To Read Paulick Report Article

Racetrack Coalition Moves Toward Lasix Ban in Stakes

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Fair Grounds among Twenty Racetracks Committed to Ending Race-day Lasix in stakes in 2021.

 

A coalition of leading Thoroughbred racing associations and organizations announced April 18 a new initiative committed to phasing out the use of the medication furosemide (Salix, commonly called Lasix) beginning in 2020 and eliminating the use of Lasix in stakes races at their tracks beginning in 2021.

Coalition racetracks that have signed on to this initiative include all tracks owned or operated by Churchill Downs Inc., the New York Racing Association and The Stronach Group as well as Del Mar, Keeneland, Lone Star Park, Remington Park, Los Alamitos Racecourse (Thoroughbred meets), Oaklawn Park, and Tampa Bay Downs. Taken together these tracks represent 86% of the stakes races assigned graded or listed status in the United States in 2018. The coalition tracks will work diligently with their respective horsemen’s associations and racing commissions toward implementing this effort.

To Read BloodHorse Article

Study Narrows Focus on How Furosemide Works

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Learning how the medication works could lead to alternative treatments of EIPH.

A recently published study in Comparative Exercise Physiology found a relationship between the administration of the medication furosemide, used to prevent exercise-induced pulmonary hemorrhage, and an enzyme that affects the pressure within the blood vessels in a horse’s lungs.

The relationship potentially points toward new avenues to explore regarding the treatment of EIPH in Thoroughbred racehorses.

The study, conducted at Gávea Racecourse in Rio de Janeiro, Brazil, analyzed post-race blood samples from 73 horses over eight race days. Of the 73 horses, 47 had been treated with 250 mg of furosemide before their race and 26 were not medicated.

These samples were then tested for levels of angiotensin converting enzyme (ACE), a potent vasoconstrictor that when active contributes to higher blood pressure. Several studies have affirmed furosemide’s effectiveness in reducing incidences of EIPH, but how the diuretic drug actually works is still unknown. This study showed ACE activity was significantly reduced in the horses that had been treated with furosemide.

“Multiple regression analysis demonstrated that pre-race furosemide significantly influenced ACE activity post-race, while distance raced, temperature, humidity, and hematocrit did not,” the study concluded. “This is a novel finding which might impact on the search for the exact implications of furosemide use, and its effects on physiology and performance of Thoroughbred racehorses utilizing loop diuretics as treatments for EIPH.”

The horses used in this study were already stabled at Gávea and the treated horses were part of the racetrack’s established protocol on managing EIPH. At Gávea, a horse is entitled to pre-race furosemide if an official racetrack veterinarian has documented a bleeding episode through tracheobronchoscopy exam. A registered bleeder can receive furosemide four hours prior to post time and must continue to receive treatment for every race within 90 days from diagnosis. Horses that are younger than 3 1/2 years old are not allowed to receive pre-race furosemide, and any medicated horse is prohibited from competing in a group 1 or group 2 race.

While furosemide has proven to be the most effective method of reducing EIPH, the medication still does not entirely prevent its occurrence. In the Gávea study, 36.2% of the non-medicated horses showed some degree of post-race bleeding compared with 76.9% of the treated horses.

“This study confirms that, although furosemide might reduce EIPH severity after a single bout of exercise, it does not abolish or reduce its occurrence,” wrote the study’s authors. “This conclusion does not argue against the use of furosemide as a treatment for control of EIPH, but indicates the continuing need for better alternatives to limit the progressive and deleterious effects of repeated episodes of EIPH on the lungs of horses, and that further research into the possible role of renin-angiotensin aldosterone system components (like ACE) in developing new treatments is needed.”

The study was published by Dr. Maria Fernanda de Mello Costa, Dr. Fernanda Aparecida Ronchi, Dr. Yoonsuh Jung, Dr. A. Ivanow, Dr. Juliana Braga, Dr. M.T. Ramos, Dr. Dulce Elena Casarini; and Dr. Ronald F. Slocombe.

Lasix Study Backs Four-Hour Administration Time

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Pair of Lasix studies of interest outline results.

A study that has some potential to reshape the timing of Salix administration ahead of racing determined that the current four-hour timeframe is more effective than administering 24 hours out in reducing the severity of exercise-induced pulmonary hemorrhage.

The study, led by Dr. Heather Knych, was one of two studies on Salix (furosemide, commonly referred to as Lasix) with results outlined at the American Association of Equine Practitioners convention in late November. The other study, led by Dr. Warwick Bayly, found some potential for a low dosage of Salix 24 hours out combined with controlled access to water in reducing EIPH in racing.

The Paulick Report first posted a story on the results of both studies Jan. 30.

According to the AAEP’s 2017 Convention Proceedings document, the study by Dr. Knych of the Ken L. Maddy Equine Analytical Chemistry Laboratory looked at the efficacy of administering Lasix 24 hours out, instead of the current four hours out called for in racing’s model rules. The study concluded that administering furosemide four hours before a race was more effective in reducing the severity of EIPH than going to 24 hours out.

The Knych study saw 15 Thoroughbreds administered furosemide either four or 24 hours prior to a five-furlong simulated race. Blood samples were collected before and after the simulated race for determination of furosemide, lactate, hemoglobin, and electrolyte concentrations.

One hour after the race, an endoscopic exam and bronchoalveolar lavage (BAL) was performed. Horses were assigned an EIPH score based on previously published criteria. The number of red blood cells in in BAL fluid was also determined.

“There was a statistically significant difference in EIPH scores between the four-hour and 24-hour furosemide administrations,” the study determined. The study noted that none of the treatments prevented EIPH in the horses but that reducted red blood cell counts in bronchoalveolar fluid post-race indicated that administering furesomide four hours before a race was the most effective.

According to its introduction, the study came together following anecdotal reports that suggested furosemide administration 24 hours prior to strenuous exercise could be equally effective at decreasing EIPH.

The United States is one of the few countries that allows the raceday administration of Lasix. A study showing efficacy in preventing EIPH at 24 hours or beyond had potential to reshape current raceday policy of administration four hours before the race.

In the study led by Bayly, it was determined that a 0.5 mg/kg administration of furosemide 24 hours before strenuous exercise combined with controlled access to water shows potential for reducing the severity of EIPH.

The study used six horses who underwent treadmill exercise to fatigue after seven different protocols that adjusted the dosage amount of the Lasix and timing of the administration. The study concluded that, “Furosemide, 0.5 mg/kg, combined with controlled access to water, significantly reduced the severity of EIPH,” adding that, “No ill effects were detected in the horses.”

In its AAEP presentation outline, the study noted that “Although the findings were promising, the number of horses used was small. The effects of furosemide on water and ion excretion were evident for 24 hours but did not adversely affect the horses, likely because of increased absorption of wager and ions from the colon.”

In September 2015, Grayson Jockey Club Foundation announced it had launched funding of the two projects. The AAEP also played a prominent role in funding the projects, along with a number of racetracks.

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