Librela: Should you believe the hype? - Pawsitively Fit Canine Rehabilitation & Wellness (2024)

If you own a senior dog with arthritis, likely you’ve heard of Librela. It is an injection given under the skin once a month to help alleviate arthritis pain. It’s touted as a safer alternative to NSAIDS (like metacam or rheumacam) by many as it does not impact the kidneys or liver.

What is Librela and how does it work?

Nerve growth factor (NGF) is a protein that is involved in sending pain information to the brain. Dogs with arthritis have more NGF, which is released from damaged cells within the arthritic joint. More NGF, more pain. Librela binds with NGF and prevents it from transmitting pain signals to the brain.

What does the research say about Librela?

Librela was approved after 2 field studies were conducted on client-owned dogs showed that it was effective in 43.5% in the study done in the EU and 47.4% in the US study.

To be included in the study dogs had to meet the following criteria:

• Osteoarthritis in at least one limb for at least one year confirmed by exam and x-rays
• Expected to benefit from arthritis treatment lasting longer than one month
• Vet rating of moderate or worse on at least one of the following: musculoskeletal condition, pain on palpation/manipulation of joints, lameness/weightbearing
• Canine Brief Pain Inventory (CBPI) pain severity score and pain interference score greater than 2
• Vet confirmed dog was in good health, any other diseases were well managed, and blood/urine tests were satisfactory

Dogs were excluded if:

• They had recently been part of a clinical trial or received other injections
• Had ever received a monoclonal antibody
• They were intended for breeding, lactating or pregnant
• Had lameness associated with primary immunologic, neurologic, infectious or neoplastic condition, ligament rupture<6 months ago, or non-healed fracture with history of injury resulting in neurological deficits or intervertebral disc disease
• Had taken any of the exclusion medications

Injections are safely administered monthly under the skin, with at least 2 doses given to determine if Librela will be effective in helping your dog with osteoarthritis pain.

The studies showed safe use of Librela for up to 9 months. There are no studies at present into longer term use.

Does Librela have side effects?

The cited side effects in the studies were relatively mild including swelling/irritation at the injection site, allergic reaction (mitigated by waiting 15-20 minutes in clinic post-injection to ensure no reaction and allow for prompt treatment if there are), urinary tract infection and increased blood urea nitrogen (BUN).

Your veterinarian is your best resource in determining if Librela is appropriate for your dog.

My concerns about Librela as a canine rehab therapist

I have several concerns. Firstly, without even considering the research, when something is touted as being a “miracle” (yes I’ve heard these words) or that it will “take away all arthritis pain” it puts the skeptic in me on high alert. The research doesn’t seem to back-up these claims. The research shows that Librela was effective in just less than half of dogs in the Librela treatment group. This is less effective than the average effectiveness of NSAIDs (non-steroidal anti-inflammatories) which is approximately 70-90%. However, there are dogs that cannot be prescribed NSAIDs due poor tolerance (e.g. vomiting or diarrhea) or due to other medical conditions . For dogs in which NSAIDs are not appropriate, Librela may be a viable alternative. If a dog does respond well to Librela, then the risks of long-term NSAID use are eliminated and this is the reason why Librela is so powerful for some dogs. I think the pros and cons for each client dog need to be considered and the effectiveness of the chosen treatment also needs to be evaluated for the best outcomes.

In the dogs that do respond very well to LIbrela and have either no or very little pain, I am then concerned about these dogs overdoing activities they haven’t done with their bodies in a long time leading to other painful injuries such as sprains and strains. If a dog with arthritis has been less active, you can assume they’ve lost muscle strength and flexibility. Allowing them back into their favourite activities immediately, without building up the body strength and stability again is a recipe for disaster. Even jumping up onto the couch, when they haven’t done it in months (or years!), may be enough for injury. In that scenario, we’ve substituted one pain for another.

I also worry that owners, without proper guidance, may throw the rest of the arthritis management puzzle out if Librela does work well for their dog. Librela is a pain modifier. It is not a disease modifier. In other words, it’s not changing the amount of arthritis damage at the joint level. It’s still there. Things like weight management, strength and balance training, joint supplements and disease modifying drugs like Cartrophen, should continue! Don’t throw the baby out with the bath water!

I haven’t experienced this first hand but I’ve heard reports from colleagues that Librela is being given for dogs with pain from causes other than osteoarthritis, such as muscle strains. This has NOT been studied. We do not know the potential risks or benefits in these dogs.

Lastly, go back and read which dogs were excluded from the study. The alarm being raised by many of my colleagues are that they have seen rapid decline and euthanasia in senior dogs who have received Librela injections that also had neurological symptoms (such as paresis, reduced reflexes or known IVDD). I believe I’ve only seen one of these cases, and it can be hard to know in every case if the results weren’t coincidental, but I personally wouldn’t take the chance if my dog had a neurological condition. NGF is key for the growth, maintenance, proliferation and survival of nerve cells. In a dog with either a known neurological condition or neurological deficits, likely they need any NGF they have. We just don’t have studies yet to back up the use in dogs with these conditions.

What else should you know?

Limited testing on the use of of Librela and NSAIDs (Carprofen) for 2 weeks at the same time has been shown to be safe. We don’t know if longer concurrent use would be harmful. In human clinical trials, concurrent dosing of NSAIDS and monoclonal antibodies for more than 4 months did lead to some cases of rapidly progressive osteoarthritis. While rapidly progressing osteoarthritis hasn’t been recognized in the dog, it’s likely important for owners to know it has been seen on the human side.

I’ve also been told by owners that they were told that if Librela isn’t effective, then the source of their pain is not osteoarthritis. This is incorrect and the research does not back up this claim. We know that Librela may be ineffective half of the time for dogs with osteoarthritis.

How else can we manage arthritis in dogs?

Sometimes going back to basics is best. Modified exercise for strength and flexibility, weight management and appropriate joint supplementation can help. If you are curious about learning more, please check our our FREE Senior Dog Arthritis Guide or The Old Dog, New Tricks On Demand Challenge.

References:

Krautmann, M et al. “Laboratory safety evaluation of bedinvetmab, a canine anti-nerve growth factor monoclonal antibody, in dogs.” Veterinary journal (London, England : 1997) vol. 276 (2021): 105733. doi:10.1016/j.tvjl.2021.105733

Corral, Maria J et al. “A prospective, randomized, blinded, placebo-controlled multisite clinical study of bedinvetmab, a canine monoclonal antibody targeting nerve growth factor, in dogs with osteoarthritis.” Veterinary anaesthesia and analgesia vol. 48,6 (2021): 943-955. doi:10.1016/j.vaa.2021.08.001

Michels, Gina M et al. “A prospective, randomized, double-blind, placebo-controlled multisite, parallel-group field study in dogs with osteoarthritis conducted in the United States of America evaluating bedinvetmab, a canine anti-nerve growth factor monoclonal antibody.” Veterinary anaesthesia and analgesia vol. 50,5 (2023): 446-458. doi:10.1016/j.vaa.2023.06.003

Millis, Daryl. (2023, November, 13). What about Librela, Anti-Nerve Growth Factor Antibody Treatment? MyLameDog.com. https://www.mylamedog.com/post/what-about-librela-anti-nerve-growth-factor-antibody-treatment

Facebook Group. Librela Experiences. https://www.facebook.com/groups/949999742415867/