We have talked before on DrBrunke.blog about osteoarthritis (OA) in dogs and the newer arthritis injection Librela (bedinvetmab). While many dogs have experienced improved comfort and mobility with this medication, there has also been increasing discussion in veterinary medicine about possible side effects and long-term safety concerns.
This new article by Yang and MacArthur reviewed multiple published studies looking at the safety of Librela. The authors compared research studies, adverse event reports, and information from both short-term clinical trials and larger safety databases. Their goal was to answer a simple question: how safe is Librela for dogs with arthritis?
The article explains that osteoarthritis is extremely common in dogs and is probably underdiagnosed. Many dogs may already have arthritis changes before they even start limping or showing obvious signs of pain. Because of this, veterinarians are always looking for better ways to control pain and improve quality of life.
Librela works differently than traditional anti-inflammatory drugs like carprofen or meloxicam. Instead of blocking inflammation directly, it blocks nerve growth factor (NGF), which is involved in pain signaling. The medication is given as a monthly injection.
The authors (Yang and MacArthur) reviewed four major studies. Three of the studies found that dogs receiving Librela for short periods of time, usually 2–3 months, did not appear to have more side effects than dogs receiving placebo injections or meloxicam. In one study, dogs receiving Librela actually had fewer stomach and digestive side effects than dogs receiving meloxicam.
However, the fourth study looked at large safety reporting databases and found that musculoskeletal problems were reported much more often in dogs receiving Librela compared to several traditional arthritis medications. These reports included:
Fractures
Joint instability
Polyarthritis
Severe joint damage
Bone changes around joints
The authors point out that these different studies have strengths and weaknesses. The shorter clinical trials were carefully controlled, but they mainly evaluated short-term use. The larger safety database studies included more real-world patients over longer periods of time.
One major point from the paper is that we still do not fully understand the long-term safety of blocking NGF in dogs (or cats for that matter). NGF appears to do more than just control pain. It also plays a role in:
Bone healing
Bone strength
Joint stability
Cartilage health
Fracture repair
Because of this, the authors explain that long-term suppression of NGF could possibly affect how joints and bones adapt and heal over time.
The paper also discusses similarities to human medicine. Human anti-NGF drugs were studied years ago, but concerns about rapidly progressive osteoarthritis (RPOA) and severe joint destruction eventually led to major concerns and halted development in people.
The authors stress that veterinarians should continue carefully monitoring dogs receiving Librela, especially over longer periods of time.
They also recommend more future studies that include advanced imaging before and after treatment so unusual joint changes can be identified earlier.
My overall takeaway is that arthritis management is rarely simple. There is no perfect medication. Every treatment involves balancing benefits and risks for each individual patient.
The most important rule is to do no harm.
Full article here: https://onlinelibrary.wiley.com/doi/10.1111/avj.70088
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