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PPID, commonly known as equine Cushing's disease, is most often managed with oral pergolide, which has become the standard treatment due to its high success rate in controlling clinical signs and hormone levels. However, a subset of horses either fails to respond adequately to pergolide or develops unacceptable behavioural or gastrointestinal side effects, leaving veterinarians and owners with limited therapeutic alternatives.
Until now, the primary alternative has been injectable sustained-release cabergoline. There is little published information on other oral treatment options.
Dr. Kellon's report, published in the Open Veterinary Journal, reviews the outcomes of five horses owned by ECIR Group members that were treated with daily oral cabergoline under the supervision of their attending veterinarians
"All horses were confirmed PPID by Cornell University Vet Diagnostic Laboratory criteria, and were considered failures of mainline therapy due to inability to control ACTH and clinical signs," Dr. Kellon said. "Based on the success in a 2022 study*, members of the ECIR Group, under the direct care of their personal veterinarians, decided to try oral cabergoline as an alternative to pergolide or injectable cabergoline."
The horses represented particularly challenging cases. All had previously failed to respond adequately to treatment with oral pergolide. Four of the five had also been treated with injectable sustained-release cabergoline, but this had been unsuccessful because of severe injection-site reactions, gastrointestinal side effects, or both. All of the horses had either longstanding PPID or rapidly progressive disease.
Despite the severity of these cases, the retrospective review found encouraging responses following the introduction of oral cabergoline. No changes were made to diet, concurrent medications, or overall management, allowing the observed improvements to be attributed to the change in therapy.
Although limited to a small number of horses, the findings suggest that daily oral cabergoline may provide a well-tolerated and effective alternative for PPID patients that cannot be successfully managed with pergolide or injectable cabergoline.
Dr. Kellon emphasised that these preliminary observations warrant further investigation. She believes additional research is needed to better understand the pharmacodynamics and pharmacokinetics of oral cabergoline in horses, establish its side-effect profile, and determine effective dosing strategies, particularly in horses with less severe disease.
While larger prospective studies will be necessary to confirm these findings, the report provides early evidence that oral cabergoline could expand treatment options for veterinarians managing some of the most difficult cases of equine PPID.
For more details, see:
Eleanor M. Kellon.
Oral cabergoline for the management of equine pituitary pars intermedia dysfunction: Five cases.
Open Vet. J.. 2026; 16(6): 3818-3825.
https://doi.org/10.5455/OVJ.2026.v16.i6.52
*Godoy, A.F. and De La Fuentes, C.I.
Cabergoline monotherapy in a Chilean creole horse with pituitary pars intermedia dysfunction (Cushing’s disease): a case report.
Clin. Res. AnimSci. (2022) 2(3), 1–4
