HRMC recommendations on betamethasone

Columbus, OH – On Sunday (May 9), Kentucky Derby winning trainer Bob Baffert (Medina Spirit) announced that his record seventh Derby winner tested positive with a level of 21 picograms (pg)/milliliter (ml) of betamethasone (Editor’s Note: A picogram is one trillionth of a gram), which is above the Kentucky Horse Racing Commission’s (KHRC) limit of 10 pg/ml that is based upon the Racing Medication and Testing Consortium’s (RMTC) misguided guideline for that medication.

“The Harness Racing Medication Collaborative (HRMC) and the U.S. Trotting Association (USTA) have been out in front of the issue of the threshold level for betamethasone of at least 100 pg/ml since it is a valuable, legal therapeutic medication for racehorses, especially for our Standardbreds who are often treated in more than one joint and race with a much greater frequency than Thoroughbreds,” said USTA President Russell Williams.

“Normal exercise stress can trigger an inflammatory response, causing native immune cells to release substances that cause tissue damage, such as to bone and cartilage in joints,” said Dr. Andy Roberts, a USTA director and member of both the RMTC and the KHRC’s Equine Drug Research Council. “Betamethasone does not mask pain and it does not improve performance when administered by a veterinarian at HRMC-recommended levels. It acts to prevent cellular destruction.

“It is critical to clarify that betamethasone is not ‘a banned steroid’ as has been erroneously reported in multiple media reports,” emphasized Roberts. “This is an absolute falsehood, in no way, shape or form is this drug banned and it would more accurately be referred to as a glucocorticoid.

“And just for everybody’s edification, this medication is commonly used in both human and veterinary medicine, from pediatrics to small animal dermatology. I would venture a guess that in any NBA or NFL game there are numerous participants that have tens of thousands of picograms of betamethasone in their systems when they play,” added Roberts.

“HRMC made recommendations to the Association of Racing Commissioners International (ARCI), once rebuffed and then came back with a scientific study validating them, and our recommendations for betamethsone’s use in harness racing have gone nowhere for more than two years,” explained Williams. “Now all of horse racing is under fire from uninformed media, horseracing critics and animal rights activists for the possibly inaccurate perception that most recognizable trainer in the biggest race in the U.S. cheated.

“If the RMTC had listened to the science and done the right thing, we wouldn’t be in this situation now,” said Williams. “It has been this way for years, as they have catered to their notion of public perception of Thoroughbred racing instead of to the health and welfare of the horse.

“What is most concerning is that RMTC Executive Director Dr. Mary Scollay and RMTC Scientific Advisory Committee Member Dr. Scott Stanley recently were named to the Anti-Doping and Medication Control Standing Committee established by the Horseracing Integrity and Safety Act, which has been challenged in federal courts on its constitutionality. If HISA is not struck down, faulty RMTC thinking will become institutionalized at the federal level.”

The threats of that federal legislation reflect the same problems that the RMTC has caused by their inaction and lack of transparency.

“The RMTC has a non-disclosure policy regarding their scientific studies and subsequent decisions on determining thresholds for therapeutic medications,” said U.S. Trotting Association Chairman of the Board Joe Faraldo. “That’s exactly what happened when they arbitrarily lowered the acceptable threshold for betamethasone from 100 pg/ml to 10 pg/ml with no disclosure of the scientific evidence for their decision.

“When our panel of eminent veterinarians on the HRMC recommended to the ARCI, along with 16 state racing commissions including the Kentucky Horse Racing Commission in December 2018 that the appropriate threshold should be set at 100pg/ml in plasma for betamethasone and a recommended withdrawal guideline of 6-1/2 days; no action was taken and it was referred to the RMTC’s Scientific Advisory Committee, weighted heavily with RMTC personnel for further consideration. The result was inevitable,” added Faraldo.

Two years later, on Thursday Dec. 3, 2020, in a presentation at the ARCI Model Rules Committee Meeting in New Orleans, LA., HRMC member Dr. Clara Fenger described some unexpectedly high serum concentration levels found in experimental horses that were demonstrated to be caused by environmental contamination in the study* she submitted as part of her proposal.

That study found that “among the biggest environmental substance offenders are dexamethasone and betamethasone.”

As a result, Dr. Fenger, on behalf of the North American Association of Racetrack Veterinarians (NAARV), who was the sponsor of the proposal, called for “alternative penalties for drug positives that are likely to result from environmental contamination and unlikely to have a relevant effect on the animal.”

Betamethasone, because it is a stereoisomer of dexamethasone, which was the focus of the study, is expected to behave in the same fashion. The study made clear that the evidence demonstrated concentrations below 100 pg/ml occur relatively commonly (1 in 50 horses at risk), produces no risk to the integrity of horse racing, and solves the problem of inadvertent environmental transfer.

She recommended to the RMTC’s Scientific Advisory Committee reduced penalties for results between 5 pg/ml and 100 pg/ml, which if adopted would have had a direct application to the current Kentucky Derby situation.

Based upon the recommendation of the HRMC and the National Horsemen’s Benevolent & Protective Association, the USTA supported that proposal.

“The RMTC should have supported it too because that’s what the science demonstrated, but they didn’t. An important part of the mission of medication and testing consortiums and regulators is to inform public opinion about veterinary sports medicine, not to hide from it. Science, not fear, will lead us to what is best for the horse,” concluded Williams.

To read the complete McClure S, Fenger C, et al. study, click here.

*McClure S, Fenger C, Kersh K, Brown B, Maylin G, Duer W, Dirikolu L, Brewer K, Machin J, Tobin T. 2020. Dexamethasone serum concentrations after intravenous administration in horses during race training. Comparative Exercise Physiology, In Press.

From the USTA