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. Veterinary Reco…+1

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. AAHA Clinical G… 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. AAHA Clinical G…+1

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. Veterinary Reco…+1 The magnitude of effect is at least equivalent to, and appears greater than, that expected from NSAIDs. Veterinary Reco… 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. Veterinary Reco…+1

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 safety profile would only be known after extensive field use. Veterinary Reco…+1

Multimodal therapy combining an NSAID with anti-NGF mAb therapy addresses the clinical reality that neither class alone is universally sufficient. NSAIDs and anti-NGF mAbs have complementary mechanisms — prostaglandin pathway inhibition versus NGF sequestration — and combination use is supported by guidelines for refractory or severe OA pain. AAHA Clinical G…+1 Amantadine is an adjunctive option when NSAIDs alone are inadequate, with evidence supporting its use in combination with NSAIDs for chronic OA pain; pharmacokinetic data in greyhounds suggest twice-daily dosing may be more appropriate than once-daily, though this has not been evaluated in efficacy studies. AAHA Clinical G…

Would you like guidance on how to counsel clients about the Librela neurological and joint destruction risks in the context of the benefit-risk discussion for a dog with severe OA pain?