By Yasmin Porritt
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April 16, 2024
If you’ve found this blog you will know by now that I’m a Canine Vet Rehabber. I want to bring together my experience with this drug, what the research is telling us and what leading experts in Veterinary Rehabilitation have to say. My opinion is just that, an opinion. I’m not here to tell you what to do, just share my thoughts on this drug to help Pet Parents make informed decisions when it comes to OA pain management. One of the most hotly debated topics in Veterinary Rehabilitation, is Librela THE answer to our pain management prayers? Is it too good to be true or do I need to stop being so cynical? What is Librela? Librela is a medicine designed to alleviate the pain associated with osteoarthritis (OA) in dogs. This solution is injected under the skin, and dosage is dependent on your dog's weight. This injection is usually administered once a month on a recurring basis. How does it work? Nerve growth factor (NGF) is a naturally occurring protein that is involved in many biological activities in the body from pain signalling to regulation of growth. Librela’s active ingredient, Bedinvetmab, is designed to bind with canine NGF and prevent communication with its receptors. In Librela’s case the aim is to interrupt pain signals, relieving the dog's sensation of pain. What are the benefits? - EFFECTIVE at relieving pain! - Vet’s don’t have to worry about treatment compliance because they are the only ones who can administer this medication. - Monthly treatments, also mean monthly checkups with your Vet on treatment progress. - Results anecdotally seen quickly, research says around a month. What are the risks? Side effects are a risk with everything we do in life, and it can be difficult to pinpoint if particular symptoms can be attributed to Librela. Usually, the demographic for dogs who are a candidate for this treatment will also have other pathologies as well as OA. Some of the side effects that have been reported, - Rapidly progressive osteoarthritis - Systematic disorders: lack of efficacy, polydipsia, death, lethargy, anorexia - Renal and urinary tract disorders: polyuria, urinary incontinence - Digestive tract disorders: diarrhoea, vomiting - Neurological disorders: ataxia, seizures Another side effect that I have seen and heard of is itching. I am yet to find any official reports of this. If your dog is on Librela or indeed any drug, any negatives should be reported to your Vet in order for them to relay this back to the manufacturer. My thoughts Librela came to the UK market in 2020 and in the USA 2023, so we are yet to understand the long-term effects of this drug. What we do have are current side effects, well the ones that have been reported. This in no way detracts from those who have suffered a devastating loss following Librela treatment, if this happened to my dog I too would be shouting from the rooftops. We need to keep listening to ALL experiences, the good and the bad. Although my listed benefits are significantly shorter than the risks involved, please don’t let this distract away from how amazing Librela is for incredibly painful dogs. Relieving a dog from osteoarthritic pain is phenomenal and it can be life-changing for certain pain management cases. What does a leading Holistic Vet have to say? Well you can blame Dr Edward Bassingthwaighte for kick starting my obsession with silent pain. He has a fabulous free lecture on this topic, which I would thoroughly recommend. In his write up on Librela he says, Stage four for me is when we throw the kitchen sink at the dog because we are only focused on quality of life, and keeping him going in as much comfort as possible for as long as possible. I’d include opiate drugs and Librela in this stage. I might also consider Librela in late stage 3 if all other options have been exhausted." (Bassingthwaighte, 2023) What does the ‘Godfather of Vet Rehab’ have to say? Any rehabber will know the legend Darryl Millis, I had the opportunity to speak to him but chickened out! Side note, ask for the selfie next time! Anyway, he concludes in his lengthy write-up on Librela, “My concerns are that other available treatments may be more effective, treatment of early osteoarthritis may result in reduction of joint position awareness, potentially increasing the progression of osteoarthritis, and there is the possibility of neurologic side effects.” (Millis, 2023) Is there a human equivalent to Librela? Nope, there isn't. NOAH, is a public access website containing current data sheets for licensed Veterinary medicine. They state, "In clinical trials in humans, rapidly progressive osteoarthritis has been reported in patients receiving humanised anti-NGF monoclonal antibody therapy. The incidence of these events increased with high doses and in those human patients that received long-term (more than 90 days) non-steroidal anti-inflammatory drugs (NSAIDs) concomitantly with an anti-NGF monoclonal antibody. Dogs have no reported equivalent of human rapidly progressive osteoarthritis." (NOAH, 2024) We are the same on a cellular level, a lot of human medicine crosses over into Vet medicine. Not the 'joint trashing' though... I mean I don't want to get my tin foil hat out on this one, but I have one for you too if you would like to borrow it. Mike drop Well what I have been thinking for YEARS has now come into fruition with the latest research from Dr Mike Farrell and a panel of experts. Musculoskeletal adverse events in dogs receiving bedinvetmab (Librela), Farrell, M et al. 2025 This paper reviewed 19 case studies with a variety of adverse events seen, one of these you can see in the image below which I don’t think needs any further explanation. This paper is a call to action, report ANY suspected side effects. Did you know it’s not just your Vet that can report to VMD but pet parents and professionals! RPOA is horrific but the scary thing is we don’t FULLY understand the mechanism of why this is occurring, or the plethora of neurological events. Not only this but the panel performed a Pharmacovigilance analysis. This involves reviewing how data is collected and assessed when it comes to reporting adverse events. The creators of Librela (Zoetis) have been downgrading adverse events reported by Vets. This can be likened to a report of a bone cancer being listed as a stubbed toe, (I made this up for illustrative purposes) Conclusion In conclusion, does Librela have its place in a pain management plan? For me, it absolutely does… in certain circumstances. Librela IS effective at relieving pain, but at what cost? This drug is so over-prescribed for EVERYTHING when (IMO) it should be used in end stage OA with no neuro conditions. - All other pain medication options have been explored and suitable ones trialled. Librela shouldn’t be (IMO) the first port of call when starting a pain management journey. If and when the efficacy dips, what else do we have to fall back on? - Things that a Pet Parent can manage such as weight control, lifestyle changes and exercise should all be fine-tuned before considering It is far too easy to make bold sweeping statements of I will NEVER use Librela, I think in fairness we need to consider what this drug is actually doing on the front line of veterinary medicine. I’ve seen dogs have the last 6 months of their life changed for the better with Librela, something we never could have achieved even with the cocktail of pain medications, physical therapy, nutrition, supplements and lifestyle management. When we’re considering quality of life, surely we want whatever time we have left for them to be comfortable? However for younger dogs, Librela as a first choice drugs for me is unforgivable. Making an INFORMED DECISION is the most important factor, knowing the RISKS and BENEFITS I would have to be REALLY pushed to use this with my own dogs last-chance saloon sort of scenario with end-stage OA. Anything that is referred to as a ‘wonder drug’ proceed with caution. This opinion may change, given time for more research… I doubt it, but never say never. Love Yaz, Lily, Rodney & Peggy Resources https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326241/ https://www.mylamedog.com/post/what-about-librela-anti-nerve-growth-factor-antibody-treatment https://www.dogsnaturallymagazine.com/librela-berensa-wonder-drug-or-disaster-in-the-making/ https://www.frontiersin.org/journals/veterinary-science/articles/10.3389/fvets.2025.1581490/full