Let’s Talk About Librela Injections | Veterinary Prescriber
Let’s Talk About Librela Injections
Librela injection is a veterinary medicine that is used in dogs for the alleviation of pain associated with osteoarthritis. Librela injections contain the active ingredient bedinvetmab, which is a type of molecule known as a monoclonal antibody.
What is bedinvetmab, the monoclonal antibody in Librela injections?
A monocolonal antibody is a molecule that has been designed to bind to a specific protein involved in a disease process.
In the name bedinvetmab, ‘-mab’ stands for ‘Monoclonal AntiBody’. Monoclonal antibodies are produced using a biological manufacturing process involving live cells to produce identical copies of the antibody for use as a treatment. Many different monoclonal antibody medicines have been created for use in human medicine, particularly for the treatment of cancers, but monoclonal antibodies are relatively new to veterinary medicine.
Bedinvetmab - in Librela injections - are one of only a few monoclonal antibody products to be licensed for use in animals.
How do Librela injections work?
Bedinvetmab - the active ingredient in Librela injections - has been designed to bind to canine nerve growth factor, to prevent it from interacting with its receptors.
Nerve growth factor (NGF) is one of several naturally-occurring proteins in the body that are known as neurotrophins. These are involved in embryo development and in the formation and maintenance of nerve cells in the central and peripheral nervous systems. Nerve growth factor is synthesised and secreted by a variety of cells in the body, including those involved in immune functions and structural cells. It is also involved in a wide range of homeostatic functions, including wound and muscle repair and in pain sensation.
The involvement of nerve-growth factor in pain sensation is mainly a result of its interaction with a cell receptor called tropomyosin receptor kinase A (TrkA). Normally when nerve growth factor binds to TrkA receptors it leads to the production of chemical transmitters (such as substance P) that are involved in pain sensation and the release of inflammatory substances from immune cells.
Nerve growth factor has been shown to be involved in joint disease and in the sensation of pain in laboratory animal models of osteoarthritis. In addition, raised concentrations of nerve growth factor have been found in dogs with chronic osteoarthritis. These findings have led to investigations about its role in the treatment for dogs with osteoarthritis pain.
The inability of bedinvetmab-bound nerve-growth factor to interact with TrkA receptors that are involved in pain sensation leads to a reduction in pain.
Librela injections - a novel treatment
Librela has been available for veterinary prescription in the UK and European Union since 2020, and in the USA since 2023. It is administered to dogs as a monthly subcutaneous injection, and represents a new way of producing pain relief because it has a different mode of action from other medicines used to treat dogs with osteoarthritis pain. Managing canine osteoarthritis can be complex and challenging, and requires a variety of different interventions (known as a multi-modal approach). These interventions are likely to include a combination of non-drug approaches (such as weight loss) as well as drug treatments.
Evaluating a new medicine
When a new medicine - such as Librela injections - first becomes available, there is a lot for a vet to get to know in order to determine how and when the treatment will be of benefit to an individual patient. This includes finding out about the following:
What is the likelihood of benefit?
What adverse effects can be expected?
What are the gaps in our knowledge about the treatment (the uncertainties)?
How does it compare with other available treatments for the condition?
Which dogs are most likely to benefit?
Are there any types of patient that should not receive the treatment?
How long does the treatment effect last?
Does it wear off in time?
When is the best time to use the treatment in terms of disease progression and in relation to other treatments?
A vet needs to know all of these answers, and be able to discuss the pros and cons of a given treatment option with the pet owner.
Why is all this information not available when a treatment is licensed?
The veterinary medicines regulator assesses new treatments for efficacy, safety and quality. A treatment is approved if the regulator judges that the benefit of the treatment outweighs the risks. The regulatory process is crucial for ensuring that high quality medicines with proven efficacy and acceptable safety are available for the treatment of animals. However, the regulatory process does not provide answers to all the questions that a prescriber needs to make a decision about the treatment of an individual animal. In addition, some of the necessary information is not always presented clearly. For instance, the type of benefit here is obvious - reduction of pain - but the size of the reduction and the likelihood of pain relief in an individual animal is not so easy to find. The unknowns about a treatment are scarcely mentioned.
This is why veterinarians need the help of Veterinary Prescriber. By subscribing to Veterinary Prescriber, vets have access to the answers they need in our independent reviews of treatments - including Librela injections - but they also get much more than that. As a subscriber you’ll also have access to our Virtual Veterinary Medicines Academy (VVMA) that is packed with informational, educational, and training resources not just for vets, but for support staff like veterinary nurses too. Even better, you have the choice to subscribe as an individual, or as an entire practice - and don’t forget that if you’d like more information on subscription, what’s involved and exactly what you get, you’re more than welcome to contact us!