betamethasone | Horse Racing Free Tips

Letter to the Editor: Joseph S. Bertino, Jr., PharmD, FCP, FCCP

I am writing to try to clear up some of the confusion concerning the science around betamethasone as it pertains to its use in racehorses. I am a (human) clinical pharmacologist and the Editor-in-Chief of the Journal of Clinical Pharmacology.

Why are there different forms (salts) of betamethasone (in this case acetate and valerate)?

Many drugs do not dissolve well in water, so other molecules are added to them so that they can dissolve in water in order to make useful dosage forms. Sometimes these other molecules are added to the drug to make them last longer in the animal when injected into something like a joint, that is, dissolve very slowly (think of a slow-release drug). Often, the betamethasone used to inject into a joint has two forms, one that is already dissolved to act sooner and one that remains in the joint and delivers [the] drug more slowly. For use on the skin, betamethasone valerate is used and can be absorbed into the animal. Betamethasone from any of these salts is the same in the animal's body; it's a potent drug used to reduce inflammation and pain and its effect is long lasting in any form.

What happens to these other molecules added to betamethasone?

The body removes these extra molecules added leaving the main drug (in this case betamethasone) to do its work. For betamethasone valerate in an ointment, some of it will be absorbed and the amount depends on the integrity of the area it is being applied to. The valerate added to betamethasone would be found in the urine along with some betamethasone valerate. For betamethasone acetate, the acetate is removed and used in the body to make other things so finding it in the urine would be quite unusual.

How does a drug like betamethasone work to reduce inflammation and pain?

Inflammation occurs due to the animal's immune system working and its reaction to an injury. The drug acts to calm down the immune system to produce its effect. Betamethasone in any salt form does not work immediately when injected in a vein, a joint, or applied as an ointment. This effect takes time to occur (at least a few hours after the animal gets the drug). Even when the drug is completely gone from the body, the effect remains for some time (hours or days) because it takes the immune system time to gear back up (and hopefully the injury is healed). So that means even if small amounts or no drug is found in the blood, the effect on inflammation and pain lingers after a dose.

Do we know the relationship of the amount found in the blood and the drugs' effect on reducing inflammation and pain?

Absolutely not, we do not know how much drug in the blood is needed to get the effect to reduce inflammation and pain. Measurement of the drug in blood is not a good indicator of the dose of the drug used or when the drug was given; it simply tells us that the animal has received the drug. This is the reason that there is such a long time between injection of the drug into a joint and when a horse can race “clean” as set up in the rules of a racing commission.

What can measurement of drug in the blood tell us?

Measurement of drug in blood can tell us how much total drug can be found in the blood of the horse but not how much total drug is in the body of the horse. For Medina Spirit, a measurement of 21 pg/mL in the blood was found the day he won the 2021 Kentucky Derby. The average blood volume of a horse is 54.5 liters (54,500 mL or 12.3 gallons). So, if you multiply 21 pg/mL x 54,500mL of blood, you get 1.14 micrograms total in the blood. The usual dose injected into a joint in a horse is 9 mg (9,000 micrograms), and since the betamethasone acetate used is designed to dissolve slowly, we would suspect that there could be more drug remaining in the joint than what is reflected in the blood.

So, what does this all mean?

Well first, betamethasone is betamethasone, it doesn't matter how it got into an animal (injection, ointment, etc.), it is active in reducing inflammation and pain. Next, finding low amounts of the drug in the blood does not tell us when the drug was last given. It does tell us that an exposure has occurred and may be ongoing. Since the drug effect is long lasting (and lasts even after the drug concentration is low or no longer measurable in the blood), a significant effect on inflammation and pain may still be occurring. Finding betamethasone valerate in the urine is not unexpected when betamethasone valerate is used as an ointment [as] some is absorbed. When using betamethasone acetate injection, finding no acetate in the urine is expected because the body uses the acetate that is shaved off the betamethasone to make other things.

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More Confusion Added to Baffert Appeal Process

With the clock ticking toward the Apr. 4 deadline for trainer Bob Baffert's looming 90-day suspension, a Kentucky Court of Appeals judge now wants to figure out whether the original venue chosen for legal action last month by the owner and trainer of disqualified 2021 GI Kentucky Derby winner Medina Spirit constitutes the correct county-level court. Dick Downey of the Blood-Horse first reported on the judge's order requesting briefs from the movants (Baffert and Zedan) and the respondent (the KHRC) covering just that single issue to be filed with the court by Tuesday.

Because of overlapping uses of the term “appeal,” it has grown difficult to keep track of the status of what has now escalated to Baffert and owner Amr Zedan's intertwined administrative and legal cases against the Kentucky Horse Racing Commission (KHRC).

At the commission level, Baffert and Zedan have already appealed the KHRC's penalties (the suspension and a $7,500 fine for Baffert, plus the forfeiture of Zedan's purse winnings from the Derby) that were handed down Feb. 21 in the wake of now-deceased Medina Spirit's betamethasone positive in last year's Derby.

But when a routine request to stay those penalties (pending the outcome of the commission-level appeal) was denied by the KHRC Feb. 25, Baffert and Zedan took the matter to Franklin Circuit Court Feb. 28.

A Franklin Circuit Court judge Mar. 21 rejected Baffert and Zedan's plea for a stay or temporary injunction to keep the penalties from going into effect, so the trainer and owner bumped up their request to the next legal level, the Court of Appeals, Mar. 24.

On Mar. 25, the Court of Appeals judge raised the out-of-the-blue issue of whether the underlying Franklin Court appeal originated in the correct venue in the first place.

As Downey reported, the question drills down to: Should the case have originally been heard in Jefferson County (specifically Louisville, where the Derby itself is run), Fayette County (Lexington, where the KHRC's offices are headquartered), or Franklin County (Frankfort, where the Kentucky Public Protection Cabinet, the KHRC's parent organization, is housed)?

But Baffert is also fighting that banishment in federal court even while contingently transferring his Derby contenders to other trainers so they can try and earn qualifying points and enter the Derby.

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Baffert, Zedan Escalate Appeals to Higher Kentucky Court

Trainer Bob Baffert and owner Amr Zedan filed motions with the Kentucky Court of Appeals on Thursday in an attempt to legally block a series of looming penalties related to the equine drug positive rulings of Medina Spirit in the 2021 GI Kentucky Derby.

The most severe of those sanctions is a 90-day suspension for Baffert that is set to start Apr. 4.

The Mar. 24 filing came barely 72 hours after a lower court rejected Baffert and Zedan's plea for a stay or temporary injunction that would have kept the suspension and a $7,500 fine for Baffert, plus the forfeiture of Zedan's purse winnings, from going into effect while the Kentucky Horse Racing Commission (KHRC) appeals process plays out.

The KHRC has a history of routinely granting stays while cases are under appeal, but it didn't in Baffert and Zedan's instance, which dates to now-deceased Medina Spirit's betamethasone positive in last year's Derby.

“Here, the KHRC has refused to follow standard procedure and stay the Stewards Rulings pending appeal,” court documents stated. “In fact, in its history, the KHRC has never denied a trainer's request to stay implementation of preliminary stewards penalties while those rulings are appealed. Never. Not once. Until now. This fact was recognized by the Franklin Circuit Court, but the Court erroneously refused to grant a stay… Absent a stay of the Stewards Rulings before April 4, 2022, the Plaintiffs will suffer immediate and irreparable harm.”

Separately on Thursday, Baffert publicly disclosed that four of his top Derby candidates are in the process of being transferred to other trainers so they can try and earn qualifying points and enter the Derby.

Even if Baffert prevails in this Court of Appeals attempt, he is still barred from having horses qualify for and run in the Derby based on a separate, private-party prohibition issued by the gaming corporation that owns Churchill Downs. But Baffert is also fighting that banishment in federal court and seeking a speedy ruling that could let him participate in the Derby while that litigation plays out.

Thursday's documents stated that the Franklin Circuit Court “abused its discretion in disregarding the immense and irreparable prejudice” to Baffert with regard to his pending suspension, offering four planks to that argument.

“First, the lower court failed to appreciate the purpose of the voluminous case precedent holding that missed professional sporting events are irreparable injuries for purposes

of temporary injective relief,” the documentation stated. “According to the Circuit Court, those cases are inapplicable because 'Baffert is not an athlete,' whose career is 'subject to a small window of eligibility or period of peak performance.'

“This is misguided even on the Court's own terms. Baffert is 69 years old; not unlike an ordinary professional athlete, Baffert's window of future opportunities is similarly limited…. There is no way to remediate Baffert's lost opportunity to participate in the prestigious races that define his reputation and the success of his career.”

The documentation continued: “Second, the lower court substantially erred in concluding that 'any harm that Baffert will suffer from not participating in the 2022 Triple Crown or other races during his suspension will result in monetary loss' and thus are not sufficiently irreparable injuries. [This mischaracterizes] the fact that money damages are typically completely quantifiable and thus, reflect adequate remedies on appeal…

“Baffert's income from racing is almost entirely linked to a horse's performance in a given race. There is simply no way to conclusively determine how his horses would have performed in the races taking place during his suspension. Missing out on the prestigious Triple Crown races (and many others) in 2022 is irreparable harm to a trainer like Baffert as the opportunity to compete in them can never be regained and the lost opportunity is not subject to remuneration,” the documentation stated.

The legal filings raised two other arguments related to the alleged abuse of discretion: That “the lower court similarly overlooks the extreme harm to Baffert's entire livelihood if [he is] forced to immediately serve the suspension,” and that the Circuit Court “abused its discretion in failing to recognize that forcing Baffert to immediately serve the suspension defeats the entire purpose of his appeal.”

The documentation summed up by alleging that “the Circuit Court misframed the issue and misunderstood the scope” of its own review.

“[Baffert and Zedan] are not, as the Circuit Court contended, attempting to 'force [the KHRC] to automatically issue stays.' Movants merely contend that when the KHRC departs from its universal practice; it must do so for valid reasons based on evidence on the record.

“In other words, the KHRC must apply the same standard that has been applied to every medication positive case to date,' the documentation stated.

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Four Baffert Derby Hopefuls Moving to Other Trainers

Four of Bob Baffert's GI Kentucky Derby prospects will be transferred to other trainers, according to a press release issued by Baffert Thursday morning.

'TDN Rising Star' Messier (Empire Maker), 'Rising Star' Doppelganger (Into Mischief) and McLaren Vale (Gun Runner) are being sent to trainer Tim Yakteen, and will remain in Southern California. Blackadder (Quality Road) has already left California and will be sent to the barn of Rodolphe Brissett in Kentucky.

Yakteen is a longtime former assistant of Baffert's, having last worked for him in 2004.

Under the suspension imposed upon Baffert by Churchill Downs, the four horses would not have been eligible to earn Kentucky Derby qualifying points or to race in the Derby had they remained with Baffert.

All four are owned in partnership by the conglomerate nicknamed The Avengers, which includes SF Bloodstock, Starlight Racing, Madaket Stables et al.

“The most important thing to me is that Messier, Doppelganger, McLaren Vale, and Blackadder–some of the top talents in racing this year–are able to compete,” said Baffert

“I encouraged the owners to move them, not only because it is best for these horses and their future in racing but also for fans of the sport who are excited to watch them run. I know that they are in good hands training with Tim and Rudy, and I look forward to cheering them on,” Baffert added.

Reached by phone Thursday, SF's Tom Ryan said that the decision came at the behest of Baffert.

“Bob was very influential in this decision,” he said. “He felt these horses were primed to take on the challenges ahead in the next round of Derby preps, and Bob felt strongly that for the horses–first and foremost–and for the sport that if these horses have the level of talent they believe they have it's only right that they have a berth in the starting gate the first Saturday in May. The Kentucky Derby is an important race.”

Messier, the winner of the GIII Robert B. Lewis S. in dominating fashion, is expected to go next in the GI Runhappy Santa Anita Derby Apr. 9 at Santa Anita; McLaren Vale, third in the GII San Vicente S., will likely head to the same race, said Ryan. Doppelganger, coming off a second-place finish in the March 5 GII San Felipe S., is being pointed to the Apr. 2 GI Arkansas Derby at Oaklawn.

“The Santa Anita Derby will probably be the best prep of the season,” said Ryan. “McLaren Vale is a big, 16′ 3″, 1,300-pound colt and he's quite claustrophobic. We tried to put him on an airplane to Arkansas and he didn't tolerate it, so he'll probably stay home and run there.”

The Arkansas Derby was also once under consideration for Messier.

“Part of the decision was would Doppelganger or Messier go there,” said Ryan. “The right thing to do is to give them individual targets. He's a very nice colt, and it feels like he's come out of his last race very well and is moving forward. Johnny [Velazquez] will ride.”

Blackadder, who broke his maiden on the dirt and won the El Camino Real Derby at Golden Gate on synthetic, will either target the GI Toyota Blue Grass S. at Keeneland Apr. 9 on the former or the Apr. 2 Jeff Ruby Steaks at Turfway on the latter.

“He's a versatile colt, bred to go on both surfaces,” said Ryan, noting that the team was probably leaning toward the Turfway race.

As for the long-term future of the horses, Ryan said he couldn't predict if they would return to Baffert or stay in their new barns.

“This is week by week,” he said. “It's a big decision. For today, we'll continue to monitor the situation as time unfolds. We'll see what happens.”

Baffert and his legal team have filed suit against Churchill Downs over the ban, along with Churchill CEO Alex Rankin.

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