What is noltrex?

Unreliable responses to joint therapy are a major source of frustration to everyone in the horse world. “The most important concept to grasp is that most joint conditions are managed, not cured,” says Dr. Craig Roberts, Veterinary Director for Noltrex®Vet at Nucleus ProVets. “When you talk about long-term joint management, the desire for the horse owner is to have a long duration of effect. The trainer wants to have the advertised therapeutic response, so no training is missed. Ultimately, everyone wants future injections to be predictable, planned events.”

These goals are now more achievable due to the introduction of Noltrex®Vet to the USA and Canada.

Noltrex®Vet is not a drug. It is a long-acting joint lubricant that is safely reabsorbed by the horse, leaving no residue.

“Noltrex®Vet has the major advantage over traditional therapies because it lasts a very long time in comparison. Longer comfort means better training and better performance,” says Dr. Roberts. “We recently shared a case on Facebook of a hunter with lower hock arthritis, which is a great example of the improvement we usually see with treatment.”

This frustrating case of lower hock arthritis involved a horse who required injections every 3 months to maintain soundness. Combination therapy of hyaluronic acid with a corticosteroid, as well as multiple biologic therapies were tried with no further improvement in the length of soundness for this horse.  Noltrex®Vet was added into this horse’s management program, and his comfort and length of time between injections improved greatly. While this is an individual case, it is a scenario that is described time and time again by veterinarians experienced in using Noltrex®Vet.

Horses with certain medical concerns also require more care when selecting joint therapy. Traditional injections with corticosteroids are often not appropriate for horses with pre-existing conditions such as Cushing’s syndrome (PPID), metabolic issues, gastric ulcers, or laminitis. Steroids can worsen these conditions, even with as small an amount that is injected into a joint. Noltrex®Vet is not a drug and can reduce or eliminate the need for steroids in these horses, as a safe alternative.

Noltrex®Vet has the major advantage over traditional therapies because it lasts a very long time.

“Noltrex®Vet is an excellent therapy to consider for any joint that your veterinarian has determined will require long-term management,” says Dr. Roberts.  The human variation of this product, Noltrex®, has been used in over 1 million people in Europe; while Noltrex®Vet has been safely used in more than 25,000 horses.

Next-gen joint lubrication for effects that last, try Noltrex®Vet.

Ask your veterinarian if Noltrex®Vet is right for your horse.

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NOLTREX™ is a synthetic implant based on three-dimensional polyacrylamide cross-linked polymer with silver ions added. It helps to alleviate the symptoms of osteoarthritis, such as mild or severe pain, joint stiffness.

A disposable syringe of NOLTREX™ contains 2.5 ml of gel to be administered into the joint cavity.

Unlike other products commonly used in intra-articular injections, NOLTREX™ does not contain hyaluronic acid or other substances susceptible to degradation under the influence of enzymes contained in the human body, which ensures its long presence in the injection site.

NOLTREX™ is a biocompatible material, that has neither immunogenic, nor antigenic properties, it does not cause allergic reaction due to its synthetic nature.

Given the complexity and the irreversibility of the processes occurring in the joints of patients with osteoarthritis, the physician should make a choice of treatment which is not only safe, but also effective. This is necessary to achieve maximum stabilization of the pathological process and prevent secondary changes in the joint. The preservation of the joint functions and the maximum reduction of the impact of the disease on the patient’s life quality depend on the effectiveness of the treatment.

There is a misconception that the use of hyaluronic acid-based products is preferable as opposed to fully synthetic preparations. Claims are often made that the preparations based on hyaluronic acid are similar in composition to the human synovial fluid. However, the trouble is that the resemblance is not absolute, which is exactly what reduces their effectiveness in terms of quality. The preparations manufactured from animal raw materials are easily detected by immune cells of the body (phagocytes), destroyed and removed from the body. Besides, the use of animal raw materials often provokes allergic reactions and inflammations in the joint. Besides, the high speed of resorption accounts for a very short recommended interval between repeated injections.

The injections of NOLTREX™ should be repeated not more often than every six months - 1.5 years.1 This is accounted for by the macromolecules of the cross-linked polymer, which are virtually invisible for phags and eliminated from the body very slowly, enabling to maximize the length of therapeutic effect. Due to synthetic origin of the preparation allergic reactions to it are rare. For long history of its therapeutic use no allergic reactions have been reported.

Thus, there is an obvious answer to the question of choice of the treatment of osteoarthritis. At the moment NOLTREX™ is the absolute leader among the medical devices for the treatment of arthritis in terms of effectiveness and safety.

Inert macromolecules of NOLTREX™ do not react with body tissues. Over the years, the researches of polyacrylamides, a group of substances on which NOLTREX™ material is based, have shown that they are highly biocompatible with human tissues, exceptionally hypoallergenic and do not have any adverse impact on the vital functions of the patient’s body.2-6

Possible side-effects and complications are related to its administration (intra-articular injection) and include: pain or swelling at the site of injection, infections (septic arthritis, osteomyelitis, sepsis, etc.), neuropathies, embolia cutis medicamentosa, aseptic acute arthritis, joint effusion, bursting sensation, burning sensation, arthralgia, granuloma.

Some of these complications of intra-articular injections in general can be avoided thorough asepsis and careful administration technique. Some of the complications reported in the studies and in the post-marketing surveillance are explained by non-compliance with the precautions and contraindications (e.g. injection into a joint with synovitis). Periprocedural or temporary postproce-dural (not exceeding 72 hours) pain or burning sensation was the most common reported complication.

The most common complication (burning sensation, pain) can be managed well with non-steroidal anti-inflammatory analgesics. As NOLTREX™ does not contain any material of animal origin, the chance of allergic reactions is very low, although not impossible: no allergic reactions or rejections were reported neither in the clinical studies nor during the post-marketing surveillance.

My colleagues and I have been working with the NOLTREX™ viscoprosthesis for over 5 years.

We have used it many times in different situations when horse lameness is a consequence of articular pathology. This made it possible to gain experience and determine the patterns when the greatest efficiency should be expected from its application.

It must be said right away that in the treatment of lameness in horses, accompanied by degenerative joint pathologies, we use an integrated approach. The use of NOLTREX™ is usually the final stage of treatment, which is preceded by anti-inflammatory therapy and the use of intra-articular chondroprotectors.

The treatment regimen for horses with acute lameness is as follows: first, we inject a chondroprotective preparation with hyaluronic acid and an anti-inflammatory component (a repository steroid), which has the goal of extinguishing the inflammatory process. After 10-20 days, we inject NOLTREX™, preliminarily injecting a little anesthetic and short-acting steroids into the joint cavity, which should prevent possible pain syndrome, which the manufacturer warns about.

By the way, in no case of using NOLTREX™ according to this scheme we received any pain syndrome, or other anxiety of the animal, or a nonspecific reaction from the joint.

For planned prophylactic interventions on a horse that has chronic degenerative changes in the joint, but is not lame at the moment, the treatment regimen is similar, but without the use of repository steroids.

For one longtime patient of mine, a horse with severe degenerative osteoarthritis of the carpal joint, I use NOLTREX™ twice a year, giving her 10-14 days of light work after injection, and the horse is able to endure sports activities without long interruptions for treatment and without lameness!