Librela; A Cutting-Edge Treatment for a Common Debilitating Disease. An Alternative Treatment for Osteoarthritis
By Paul Magrath, DVM
What is Arthritis?
Arthritis, also known as osteoarthritis or degenerative joint disease, is a degenerative, progressive, irreversible condition of the joint which leads to loss of joint cartilage, bony spurs/growths and scarring and/or thickening of connective tissue around the joint. About 25% of dogs will be diagnosed in their life time and as many as 60% of dogs will have evidence of arthritis on x-rays.
How do we diagnose arthritis?
Diagnosis is typically based on physical exam findings and x-rays. Common clinical signs include lameness/limping which can happen infrequently or can be persistent. Stiffness is common after episodes of rests but improves as your pet moves around. Lameness often worsens after periods of overexertion. Over time your pet may develop pain, swelling and decreased range of motion in their joints.
Treatment, Management and Prevention:
It is important to note that arthritis is an incurable condition. Our goals are to alleviate your pet’s discomfort, to minimize further degenerative changes to the joint and attempt to restore the joint’s functionality. Treatment is multimodal (i.e. multiple types of treatments are used to relive pain, stiffness and discomfort.
First and foremost, weight management is crucial. Excessive weight can increase stress on the joints and muscles. If your pet is overweight, we can help you to help them lose weight by designing a nutrition and exercise plan to help in weight loss.
Joint supplements are also helpful and known to protect the cartilage in bones to support the cartilage and will have some anti-inflammatory effects. They slow the breakdown of cartilage and provide the building blocks to help build cartilage. Some products also increase joint fluid secretion and thus decrease inflammation. Diets rich in omega-3 fatty acids also help reduce inflammation.
Non-steroidal anti-inflammatory drugs (i.e. NSAID’s) are another crucial component of arthritis management. NSAID’s work by inhibiting an enzyme cyclooxygenase (COX). There are two cyclooxygenase enzymes (COX-1 & COX-2). COX-1 is expressed in the body and plays role in maintaining gastrointestinal mucosa lining, kidney function and platelet aggregation. COX-2 expresses during an inflammatory response. NSAID’s work by blocking the COX pathway. However, most NSAID’s are not
selective meaning they block both COX-1 & COX-2. Because of this, they typically have other side effects including gastrointestinal ulcers, kidney and liver disease if they are used chronically. This is why it is critical to get baseline bloodwork and monitor yearly for changes to these enzymes as well as monitoring for loss of appetite, vomiting and diarrhea. Some pets have underlying liver, kidney or GI disease or have poor reactions to NSAID’s, precluding them being able to take NSAID’s. Examples of veterinary NSAID’s include Rimadyl, Meloxicam and Galliprant. You should never give your pet an NSAID (especially an NSAID designed for humans) without consulting your veterinarian first.
What is Librela and how is it different than a traditional NSAID?
Librela is part a class of medications called a monoclonal antibody. It is a once a month injection, administered by your veterinarian, to treat canine osteoarthritis. Monoclonal antibodies are laboratory-produced molecules that are engineered to serve as substitute antibodies (which the immune system normally produces on their own to help the immune system recognize germs that cause disease, such as bacteria and viruses, and mark them for destruction) to restore, enhance, modify or mimic the immune system’s attach on cells that aren’t wanted. More specifically, Librela is a potent inhibitor of canine nerve growth factor (i.e. canine NGF) a key osteoarthritis pain mediator which in turn helps reduce canine arthritis pain and limits the release of additional NGF and pro-inflammatory mediators and lowers neurogenic inflammation. Because Librela is a monoclonal antibody, it specifically targets NGF and is metabolized and eliminated like naturally occurring antibodies, with minimal involvement of the liver or kidneys.
Is Librela effective and safe?
Two clinical trials (one in UA and one in EU) with a total of 559 dogs showed Librela was effective in reducing canine OA pain, which can improve overall quality of life. The percentage of dogs considered treatment successes was greater in the Librela group as compared to the control group. Librela is also very safe. Clinical signs were rare but the most common adverse events reported were urinary tract infection, bacteria skin infection, dermatitis and increased blood urea nitrogen (BUN). Since Librela is metabolized and eliminated naturally there is minimal involvement of the liver or kidneys. This means that animals that Librela is safe to use in dogs with underlying liver or kidney disease unlike most traditional NSAID’s. Librela should not be administered to breeding, pregnant or lactating dogs and has not been studied in dogs under 12 months of age.
Summary
All in all, canine OA is a debilitating, chronic, progressive disease the will greatly impact a lot of dogs’ overall quality of life as they age. The good news is there are several treatment options to help including joint supplements, fatty acid supplements/prescription diets, NSAID’s and Librela. Most dogs will not whine like they are painful, so it is important to monitor for increased stiffness/soreness, reluctant to go up or down stairs, reluctance to jump and trouble rising. You should talk with your
veterinarian if you are concerned your pet has OA. We are here to help, and want to give your pet the best quality of life they deserve.
