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Canine osteoarthritis is a progressive joint disease and the leading cause of chronic pain in dogs. Fortunately, early diagnosis and a comprehensive treatment plan can significantly slow the disease’s development. Treatment of canine osteoarthritis is multimodal, typically involving a combination of therapies. The goal is to reduce pain and increase mobility, helping your dog maintain a high quality of life for as long as possible.
Librela is an injectable pain management drug for canine osteoarthritis that’s new to the market in the US. Whether it’s worth considering as part of your dog’s toolbox of treatment options depends on various factors.
What Is Librela, and How Does It Work?
Librela is an antibody that helps block pain resulting from osteoarthritis in dogs. “Specifically, it is an anti-Nerve Growth Factor monoclonal antibody (mAb),” says Dr. Leilani Alvarez, Head of Integrative & Rehabilitative Medicine at NYC’s Schwarzman Animal Medical Center. “Nerve Growth Factor (NGF) is important in the early development of the nervous system in puppies. In adulthood, NGF is associated with higher states of pain, particularly chronic pain, and has been found in high levels in dogs suffering from osteoarthritis.”
When To Use Librela
Librela is an exciting new veterinary medicine and a particularly useful pain-controlling alternative for dogs that can’t tolerate non-steroidal anti-inflammatory drugs (NSAIDs). However, that doesn’t mean it will suit every dog with an osteoarthritis diagnosis. Dr. Patsy Mich, DVM, MS, DABVP, DACVAA, DACVSMR, CCRT, is a small animal pain management and mobility specialist. She says careful patient selection is warranted, and she only recommends Librela in specific cases.
“The ideal candidate for Librela has uncomplicated osteoarthritis,” Dr. Mich says. “That means overall the dog is healthy and does not have concurrent health issues, most notably neurological symptoms or conditions.” So, if your dog has a condition such as intervertebral disc disease, degenerative myelopathy, or lumbosacral stenosis, they will not be a suitable candidate for the drug.
Dr. Alvarez doesn’t recommend Librela as a postoperative pain management tool for dogs with osteoarthritis, as the impact on healing is not known. As Librela has only been evaluated for dogs with osteoarthritis in the joints of limbs, she also says she wouldn’t recommend the drug for dogs with pain related to conditions of the spine or a torn ligament or muscle.
“Dogs under the age of one year should not receive Librela because their nervous systems are still developing,” Dr. Mich says. The drug is also not suitable for breeding, pregnant, or lactating bitches.
Effectiveness and Limitations
Librela might be new to the US market, but European veterinarians have been using it for over two years with promising feedback, and results from studies so far are supportive. “We have a few well-conducted, prospective, double-blind clinical trials that demonstrated Librela’s efficacy in relieving the pain associated with canine arthritis,” Dr. Alvarez says.
However, she points out that these were sponsored studies that may present a risk of bias, and researchers didn’t test the the drug on geriatric dogs (dogs at life expectancy or beyond). “Old dogs often have other problems, and we are still trying to learn if Librela is safe in this population of patients,” she says.
Dr. Mich says there’s always a need for more research to further define the efficacy and adverse effects of any new product. “I would like to see head-to-head comparisons with traditional osteoarthritis therapies such as non-steroidal anti-inflammatory drugs (NSAIDs),” she says. “I would also like to see more studies using objective outcome measures like gait analysis.”
And, while using Librela could make a big difference to the quality of life of dogs with osteoarthritis, in rare and infrequent cases, the injections could lose effectiveness over time.
How To Administer Librela?
One benefit of Librela is that you don’t need to remember to give your dog a daily pill. If your veterinarian deems your dog an appropriate candidate for the drug, they’ll administer it as a monthly injection. This prescription drug is not suitable for at-home administration. Attending these regular appointments also allows your veterinarian to evaluate your dog’s overall treatment strategy and monitor any weight loss program.
As with any drug, allergic reactions are possible. While this is rare, Dr. Alvarez observes patients for 30 minutes following the first three injections of Librela to ensure there is no immediate adverse reaction.
You could see improvements in your dog as soon as one week after the first injection, but it can take two monthly injections to reach maximum effect. If you don’t see an improvement in your dog after this time, discuss other treatment options with your veterinarian.
What Are the Common Side Effects?
Librela is well-tolerated by most dogs. However, side effects are still possible. The most common include:
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Skin reactions (dermatitis) at the injection site
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Bacterial skin infections
Another potential side effect is a rise in blood urea nitrogen (a value associated with kidney function) without evidence of kidney problems. Because of this, some veterinarians may want to take baseline blood work before treatment starts.
There have also been reports of polydipsia, polyuria (increased thirst and, consequently, increased urination), and worsening of pre-existing neurological conditions. Dr. Mich says that, as is typical for new therapies, additional adverse effects may come to light as veterinarians deliver more doses.
Other Treatment Options for Canine Osteoarthritis
“While Librela is an exciting addition to our arthritis pain management toolbox, it is not a panacea for all pain,” Dr. Mich says. She says it is vital for veterinarians to evaluate each osteoarthritis patient thoroughly to diagnose all primary and secondary pain issues.
When it’s appropriate to prescribe Librela, it should be a component of a comprehensive treatment plan, rather than used in isolation. “Osteoarthritis is a complex disease, and we know from multiple studies that combined approaches are more effective for long-term management,” Dr. Alvarez says. “Most importantly, dogs with osteoarthritis should be in an ideal or slightly thin body condition.”
She also points out that because Librela only targets the pain caused by osteoarthritis, joint protective strategies are crucial.
Alongside a carefully managed weight loss program for overweight dogs, other canine osteoarthritis treatment options include:
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Alternative pain management tools: “Librela can take several weeks to become effective, and if a dog is in pain, we use other strategies for pain relief,” Dr. Alvarez says. “This may include non-steroidal anti-inflammatory drugs (NSAIDs), like carprofen, amantadine, cannabidiol (CBD) or cannabidiol acid (CBDA), Adequan, joint injections, and acupuncture.”
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Exercise: “Moderate daily low-impact activity (at least 60 minutes of walking per day), swimming, strength training, and targeted rehabilitation are all very important,” Dr. Alvarez says. Limit high-impact activities, such as running or jumping.
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Rehabilitation: “This can include manual therapy, patient-specific and progressive therapeutic exercise programs, modalities such as TENS, LASER, therapeutic ultrasound, and extracorporeal shockwave, and spinal manipulation,” Dr. Mich says.
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Diet: “Prescription joint diets that are low in carbohydrate, moderate in protein, and high in omega-3 fatty acids have been shown to reduce the symptoms of OA in dogs,” Dr. Alvarez says.
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Surgery: In some cases, surgery, such as repairs or replacements of joints, is the most effective treatment choice.
A Note About Supplements
If Dr. Mich uses supplements to help dogs with arthritis, they are the lowest priority on her list of treatment options, and it’s a highly curated selection due to the lack of evidence for nearly all types. She also highlights that the clinical impact is quite modest when they are effective.
Dr. Alvarez explains that the highest level of evidence has shown that, despite previously widely held beliefs, oral glucosamine or chondroitin supplements are not more effective than placebos. “We have higher evidence for fish-based omega-3 supplements, green-lipped mussel, undenatured collagen, and cannabidiols,” she says.