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Summary Helminth infections remain highly prevalent among grazing equids worldwide, with cyathostomins and the tapeworm Anoplocephala perfoliata representing the most widespread parasites. Whilst most horses tolerate low helminth burdens without overt clinical signs, a minority develop higher burdens that can result in substantial intestinal pathology. Infection with A. perfoliata burdens exceeding 20 worms has been strongly associated with mucosal ulceration, ileocaecal valve dysfunction and various forms of colic. Consequently, mounting evidence of reduced anthelmintic efficacy against A. perfoliata represents a growing concern, particularly in light of the apparent absence of a drug development pipeline for equine anthelmintics. This situation highlights the need for sustainable, evidence‐based control strategies that favour diagnostic‐led treatments over routine blanket deworming. Traditional coprological methods, although integral to nematode control, lack sensitivity for detecting A. perfoliata infection due to the parasite's intermittent egg shedding behaviour, typically low faecal egg output and the fact that infections may comprise high proportions of immature or non‐gravid adult tapeworms. In contrast, serological and salivary immunoassays targeting parasite‐specific IgG(T) provide a more sensitive means of assessing infection status, with antibody levels shown to correlate with tapeworm infection levels. Incorporation of these tests into helminth control programmes enables targeted treatment of infected horses whilst minimising unnecessary anthelmintic use in individuals with little or no tapeworm infection. When combined with robust pasture management practices, including regular faecal removal, maintenance of low stocking densities, rotational grazing with non‐equine species and adequate paddock rest periods, diagnostic‐led approaches can substantially reduce reliance on anthelmintics. This not only helps preserve drug efficacy through the maintenance of refugia but also supports sustainable long‐term control of equine tapeworm infections. However, there remains an urgent need to develop validated methods for assessing anthelmintic efficacy against A. perfoliata , which should be a key priority for future research.