Quickfire 10 is our firefighting approach to pain! 10 questions, bringing you right up to speed!
What is the licence indication for Librela?
Librela is indicated for the alleviation of pain associated with osteoarthritis in dogs.
What is the active ingredient in Librela?
Librela contains bedinvetmab, a canine-specific monoclonal antibody.
How does Librela work?
Bedinvetmab targets nerve growth factor (NGF), which is an inflammatory mediator produced by the tissue damage of OA. The receptor for NGF is the TrKa (tropomyosin kinase related) receptor. Binding of NGF to the TrKa receptor sensitises the nociceptor to other inflammatory mediators.
Does NGF contribute to central sensitisation?
The NGF/TrKa complex transits to the dorsal root ganglion of the neuron where it leads to upregulation of ion channels and neurotransmitters. These travel anterograde to the nerve terminal where they increase pain transmission. This is known as neurogenic inflammation. The increase in transmission in the neuron augments traffic at the dorsal horn and so is highly likely to lead to central sensitisation.
Can I use Librela alongside NSAIDs?
In field trials Librela was used alongside NSAIDs for 2 weeks to demonstrate that dogs already receiving NSAIDs can be transitioned to Librela. It actually makes perfect sense to use the two drugs together as they act on different elements of peripheral sensitisation.
Would you use Librela in a newly diagnosed case of arthritis?
Licensed options for newly diagnosed OA are Librela, NSAIDs or grapiprant. Decision making here revolves around convenience and compliance. In my experience, Librela is an effective option as a sole agent in mild to moderate cases of OA.
What were the outcome measures used in the trials?
The main outcome measure was pain scores using the Canine Brief Pain Inventory. Over the initial 8 week period (with an injection every 4 weeks), both the pain severity scores (PSS) and pain interference scores (PIS) improved, as did quality of life.
Tip – sum the four PSS scores and divide by 4 to give a number out of 10. Sum the six PIS scores and divide by 6 to give a number out of 10. And ask owners to complete the CBPI blinded to the previous results. Save consulting time by asking them to complete this while they wait.
How long does Librela take to work?
In the trials, the first evaluation point was 7 days. Some owners report an effect sooner, with others commenting that it takes longer for comfort levels to change.
Can I use Librela in cats?
Monoclonal antibodies are species specific. There is a cat mAb licensed for OA which is frunevetmab (Solensia).
Is Librela suitable for dogs with renal disease?
With renal disease we face challenges with NSAIDs due to the uncertain effect on renal prostaglandins. Bedinvetmab does not directly affect prostaglandin levels. Although not tested in dogs with renal disease, there is no reason not to use bedinvetmab in these cases and I think this is a great option to improve comfort in those dogs.
My view?
Targeting NGF is a totally novel approach to OA. I’ve seen a number of dogs benefit significantly from treatment and Librela has a firm place in my treatments for OA.
For an explanation of the role of NGF in pain and a review of the literature, please watch our webinar.
This post was written by Matt Gurney.
Matt sees referrals in the pain clinic at Anderson Moores Veterinary Specialists. You can also receive telemedicine advice from us here if you have a pain case where you need a helping hand.
Matt & Carl established Zero Pain Philosophy to provide educational resources & telemedicine to veterinary professionals enabling optimal management of pain.
Matt Gurney is an RCVS & European Specialist in Veterinary Anaesthesia & Analgesia and works at Anderson Moores Veterinary Specialists. Matt is President of the European College of Veterinary Anaesthesia & Analgesia.
Carl Bradbrook is an RCVS & European Specialist in Veterinary Anaesthesia & Analgesia and is President of the Association of Veterinary Anaesthetists. Carl works at Anderson Moores Veterinary Specialists.
The intended audience for this pain update is veterinary professionals. This pain update is based on clinical experience and independent opinion.