In the US, the FDA has recently approved Librela (bedinvetmab), a new arthritis drug for dogs … but it’s been available in Australia (under the name Beransa), Canada, the EU and UK for some time. It’s a monoclonal antibody drug that’s injected monthly to manage osteoarthritis pain.
There’s some important information you need to know about Librela (or Berensa in Australia), how it works and the risk of side effects. First, let’s look at what a monoclonal antibody is.
What Are Monoclonal Antibodies?
Monoclonal Antibodies (mAb) have been used in human medicine since 1988, and there are quite a number of these kinds of medicines that have gained approval and are being used in the fields of oncology, inflammation, and autoimmunity. They are an artificially created antibody. In nature, antibodies are created by your dog’s B-lymphocytes and are created as part of a natural immune response to foreign molecules on invading disease cells/viruses, or on cancer cells.
Natural antibodies are targeted to bind to these foreign or cancerous molecules, as part of the body defending itself. However, if the immune system becomes dysregulated, the body may create antibodies that bind to self-proteins. This causes the body to attack itself, and results in autoimmune diseases.
Key point: if antibodies bind to healthy proteins in the body, it often causes harm and upsets the homeostasis of the organism.
The mechanism of action in mAb’s such as Librela for dogs is to block or down-regulate specific proteins or receptors that are involved in cascades of inflammatory, regulatory, and homeostatic mechanisms. These receptors are nearly always found throughout a broad range of tissues in the body. I’ll explain why this is important a little later on.
Monoclonal antibodies also include Cytopoint, which is used to treat atopy/allergies. I wrote a separate article about why I don’t recommend Cytopoint – click on the link below to read that.
How Librela Works
Librela for dogs is a monoclonal antibody medicine designed to relieve arthritic pain by blocking the effects of Nerve Growth Factor
Librela acts by binding to and blocking a protein in your dog’s body called nerve growth factor (NGF). Once this artificial antibody has bound to NGF, it prevents it from attaching to its receptors on nerve cells and interrupts the transmission of pain signals.
BUT – and it’s a very big but! – NGF has many other functions in many other tissues throughout your dog’s body. It’s not only involved in pain signaling, but it’s very important for the growth, maintenance, and survival of nerve cells in the central and peripheral nervous system.
It regulates the growth and differentiation of B-lymphocytes and in the maturation of T cells in the face of infection. It has an important role in the regulation of your dog’s immune system. It’s involved in the maintenance and survival of pancreatic beta cells (insulin production). And it’s probably involved in other processes that science has not yet elucidated.
Librela Can Reduce Arthritic Pain In Dogs – But At What Cost?
So yes, it does reduce arthritic pain, with a 60-70% chance of significant positive effects. But it does so by blocking a protein that has multiple other regulatory effects throughout multiple body systems, including your dog’s immune system. It binds NGF everywhere. Not only in the painful area, where there is too much of it, but in all the places it’s needed for optimal health and vitality.
I see this as a bit like trying to slow down or speed up a mechanical watch by putting some very fine grains of sand into the mechanical works that affect one cog in the way that’s desired, but that clog up all sorts of other cogs that are critically important. Sometimes it’ll work. Other times you damage or break the watch!
Librela For Dogs Side Effects
There is a 10-20% chance of minimal positive effects and no negative effects. And a 2-10% chance of adverse effects. Some adverse effects are significant, including a “small” chance of irreversible injury that could lead to death, or need for euthanasia before the medicine has worn off. Librela has a variable half life, with an average of 19 days. That means 50% is gone in 19 days, 75% is gone in 38 days, and so on.
The problem here is that if your dog is more sensitive to the bad effects of this medicine, once it’s injected into his body, it’s there for a long time. And it’ll keep causing harm until the body slowly clears it out. Adverse effects tend to wear off over days to several weeks.
The listed side effects on the Canadian insert for this medicine (much more comprehensive than in other countries!) include:
- Swelling at the injection site
- Systemic disorders: lack of efficacy, polydipsia, death, lethargy, anorexia
- Renal and urinary tract disorders: poluria, urinary incontinence
- Digestive tract disorders: diarrhea, vomiting
- Neurological disorders: ataxia, seizure
The US prescribing information lists the most common adverse reactions as …
- Urinary tract infection
- Bacterial skin infection
- Dermal mass
- Dermal cyst(s)
- Pain on injection
- Inappropriate urination
These are ugly lists. Not to mention that many elderly animals already have compromise or disease in multiple organ systems. So this medicine may be the straw that breaks a whole lot of camel’s back in your dog’s system.
It’s proposed that propentofylline (Vivitonin, Karsivan) may be of some value in aiding dogs with adverse effects, as it increases NGF. Discuss this with your vet if your dog experiences side effects.
My view is that if you shut down any pathway in your pet’s body, the chances of unintended harmful consequences are significant. I believe that these kinds of medications tend to become less effective with repeated treatment, and more likely to cause harm with repeated treatment.
Real Life Side Effects
Although there often isn’t proof that these side effects are linked to Librela, there is much anecdotal experience with adverse symptoms after Librela/Berensa injections. Sometimes these appear within a few days of the first injection. Other times it may be after several months’ injections.
There’s no question that for some dogs it’s proven life-saving or life-extending, reducing pain so they regain activity and are able to run and play again, while experiencing minimal side effects. The reported improvement in quality of life in these dogs is significant.
However, many dogs, even those who do well on Librela, show lesser side effects like increased panting, thirst and urination.
Other owners (in the Librela Experiences Facebook group) report much more serious adverse effects, including …
- Drooling, shaking
- Change in behavior, acting scared, hiding
- Urinary incontinence
- Refusing food or water
- Diarrhea, vomiting
- Ataxia, staggering, falling over
- Hind end weakness, unable to get up
- Kidney or liver damage
- Seizures (new or increased)
While some dogs are able to hang on until the drug wears off and their condition improves, others don’t survive because the symptoms are too severe and require euthanasia.
It’s also noteworthy that many veterinarians reassure their clients that there are no side effects with Librela. So you need to do your own research before deciding to use it.
Another caution owners mention is that Librela manages pain and stiffness, but doesn’t improve the underlying osteoarthritis. Some suggest controling activity for some dogs who suddenly become much more active after taking the drug. Dogs who suddenly feel pain-free are reportedly inclined to overdo things, which may result in further joint damage.
Is There Any Place For Librela In The Treatment Of Arthritis In Dogs?
In my professional opinion, there is no way that Librela should ever be considered as a first treatment or intervention for arthritis in dogs.
You should always start with high dose essential fatty acids (omegas), green-lipped mussel extract, +/- turmeric +/- epitalis +/- rosehip +/- homeopathy +/- physical therapies. I’d think of this as stage one of arthritis treatment.
Stage two for me would include the addition of CBD +/- western or TCM herbal medicine +/- acupuncture or acupressure +/- laser +/- hyperbaric alongside regular physical therapies.
Stage three is when all the holistic options are not enough, and breakthrough pain becomes an issue. Here’s where I stop worrying too much about side effects, and focus on palliative care for quality of life. I’d then escalate to pulsed (bad days as needed) and then continuous treatment with prescription pain relief like NSAIDS +/- Gabapentin +/- amantadine or ketamine injections.
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.
My Recommendation: Avoid mAB Medicines Unless They Are Your Final Option …
I believe that these monoclonal antibody medicines (Librela/Beransa, Cytopoint) carry a significant risk of harm and injury that may be temporary or permanent. As mentioned earlier, I’m seeing a large number of people anecdotally reporting side effects after treatment with these drugs. You’ll find a number of Facebook groups.
And – as a few of my colleagues shared at a holistic/integrative veterinary conference I attended last week – Librela/Beransa can be a highly effective medicine that can be incredibly helpful for some dogs. So it may be worth considering if you are running out of options, but you need to be aware of the very real risk so you can make a truly informed decision.