I know this is an article on prevention, but do you have any experience with the new drug Librela for treating chronic musculoskeletal pain in dogs? We've been giving it to our little dog Jack for about 3-4 months and it seems to be helping. I do know there is some controversy over whether it can help or hurt patients with intervertebral disk disease like he has (he also has chronic OA in other joints)
You're one step ahead. I have a piece on management coming out tomorrow where I touch on this briefly.
It's a difficult one. Librela is something we're prescribing quite often in NL and I've seen variable responses ranging from mild improvement to wondrous improvement. I did have one patient that didn't respond well (no response to perhaps mild worsening of signs, which stabilized after discontinuing the drug; this patient did not have known IVDD upon initiation of therapy). That being said, the majority of patients I have had on this drug I've seen in a locum/relief setting where I either 1) haven't been the initial prescribing vet, or 2) haven't monitored the patient exclusively or very long-term. It's also difficult to say as the drug has been available for such a short period that nobody has really been on it very long-term. I also haven't prescribed the drug for any patients with known IVDD or other history of neurologic disease, so I may be selecting for a positive response group.
I have a close colleague / former mentor who's an internist at AMC and he's seen significant paresis / neurologic deficits in association with Librela administration in certain patients, severe enough to the point where owners were considering euthanasia, but signs resolved within a week or two.
I would be wary to use Librela in a dog with IVDD, but ultimately I think you have to weigh the potential benefit/risk for your specific dog. Has the dog had neurologic deficits in association with its IVDD in the past? How severe is the IVDD? What breed is the dog? Dachshund, Pinscher, Frenchie = potential yikes? But that's what's most difficult -- it's impossible for us to predict which dogs have a damaged basement membrane and permeable BSCB. And if your dog is responding well now, there's no way for us to know if he will experience side effects at any point in the future with progression of his IVDD or other disease.
It's definitely a risk. But if your dog is in significant pain that is obviously compromising his quality of life, you're out of other options, and he's responding well to Librela, what are you going to do? Maybe you have to take that risk. But I would proceed with caution... and make a plan for how you're going to manage the case if/when things go south.
I know this is an article on prevention, but do you have any experience with the new drug Librela for treating chronic musculoskeletal pain in dogs? We've been giving it to our little dog Jack for about 3-4 months and it seems to be helping. I do know there is some controversy over whether it can help or hurt patients with intervertebral disk disease like he has (he also has chronic OA in other joints)
You're one step ahead. I have a piece on management coming out tomorrow where I touch on this briefly.
It's a difficult one. Librela is something we're prescribing quite often in NL and I've seen variable responses ranging from mild improvement to wondrous improvement. I did have one patient that didn't respond well (no response to perhaps mild worsening of signs, which stabilized after discontinuing the drug; this patient did not have known IVDD upon initiation of therapy). That being said, the majority of patients I have had on this drug I've seen in a locum/relief setting where I either 1) haven't been the initial prescribing vet, or 2) haven't monitored the patient exclusively or very long-term. It's also difficult to say as the drug has been available for such a short period that nobody has really been on it very long-term. I also haven't prescribed the drug for any patients with known IVDD or other history of neurologic disease, so I may be selecting for a positive response group.
I have a close colleague / former mentor who's an internist at AMC and he's seen significant paresis / neurologic deficits in association with Librela administration in certain patients, severe enough to the point where owners were considering euthanasia, but signs resolved within a week or two.
I would be wary to use Librela in a dog with IVDD, but ultimately I think you have to weigh the potential benefit/risk for your specific dog. Has the dog had neurologic deficits in association with its IVDD in the past? How severe is the IVDD? What breed is the dog? Dachshund, Pinscher, Frenchie = potential yikes? But that's what's most difficult -- it's impossible for us to predict which dogs have a damaged basement membrane and permeable BSCB. And if your dog is responding well now, there's no way for us to know if he will experience side effects at any point in the future with progression of his IVDD or other disease.
It's definitely a risk. But if your dog is in significant pain that is obviously compromising his quality of life, you're out of other options, and he's responding well to Librela, what are you going to do? Maybe you have to take that risk. But I would proceed with caution... and make a plan for how you're going to manage the case if/when things go south.