which NSAIDs and monoclonal antibodies are most effective for managing OA pain in dogs?

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For canine OA pain, bedinvetmab (Librela) and the COX-inhibiting NSAIDs represent the two highest-evidence pharmacological options, with anti-NGF monoclonal antibody (mAb) therapy producing analgesic effects equal to or greater than those expected with NSAIDs from a single monthly injection. 12 Among NSAIDs, COX-inhibiting agents are tier 1 first-line therapy for canine OA pain based on the ubiquitous role of prostaglandins in peripheral and central pain processing. 2 Grapiprant, a non-COX-inhibiting NSAID and EP4 receptor antagonist (piprant class), is also tier 1 and carries the highest evidence base alongside COX inhibitors. 23 Bedinvetmab (Librela), a fully canine anti-nerve growth factor (anti-NGF) monoclonal antibody, is approved for OA pain in dogs and is administered as a single subcutaneous injection providing at least 4 to 6 weeks of analgesia per dose. 12 The magnitude of effect is at least equivalent to, and appears greater than, that expected from NSAIDs. 1 Anti-NGF mAb therapy is particularly relevant as a non-opioid alternative and as an option when NSAIDs are insufficient as monotherapy or carry tolerability concerns. 12 Critical safety update — FDA December 2024 Dear Veterinarian Letter and February 2025 Librela label revision: The FDA issued a Dear Veterinarian Letter in December 2024 identifying neurological adverse events associated with bedinvetmab, including ataxia, seizures, and neurological signs, as well as musculoskeletal adverse events including suspected accelerated joint destruction. The February 2025 label update incorporated these findings. Clinicians should inform clients of these risks prior to initiating therapy and monitor patients receiving bedinvetmab for new or worsening neurological signs and for unexpected deterioration in joint function. The veterinary literature prior to these regulatory actions described the safety profile of anti-NGF mAbs as not associated with organ-related adverse effects, but acknowledged that the full