Librella Safety Update

Hello Summarians!

A drug that makes arthritic dogs feel dramatically better may be quietly destroying their joints. Human regulators rejected a similar drug for exactly this reason, and some dogs are now showing the same pattern.

This week also brings a survey of 1,125 veterinarians: client verbal abuse is nearly universal in the profession, with more than a third considering leaving because of it. And how a dog walks may reveal whether its brain is declining.

Three studies. None of them comfortable.

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Client Aggression

This study examined the prevalence and effects of client-perpetrated aggression toward veterinarians using an anonymous survey of 1,125 practitioners, primarily from the United States and Canada. The findings revealed that client aggression is nearly universal within the profession. Almost 99% of respondents had experienced verbal abuse during their careers, 38% had been physically threatened, 4% had been physically assaulted, and nearly 12% reported being stalked by clients. Verbal abuse occurred most often in relation to the cost of care, communication problems, long wait times, client stress, and unrealistic expectations. Female veterinarians and emergency clinicians reported higher rates of verbal abuse, while female veterinarians were also more likely to experience physical threats.

The psychological impact of client aggression was substantial. The most common consequences included intrusive thoughts, anxiety, sleep disturbances, hypervigilance, fatigue, irritability, and decreased empathy toward clients. Although many symptoms resolved within a few days, a significant proportion of veterinarians experienced anxiety, hypervigilance, and intrusive thoughts lasting longer than one month. More than one-third of respondents reported considering leaving the profession because of verbal abuse, and many developed greater cynicism toward clients, the profession, and people in general. Stalking produced particularly severe and persistent psychological effects, with many victims fearing for their personal safety and experiencing prolonged emotional distress.

The study also identified important shortcomings in workplace support. Fewer than half of respondents reported having formal policies or reporting systems for managing client aggression, and over half had received no formal de-escalation training. Private practices were more likely than corporate practices to have clear policies, dismiss abusive clients, and provide stronger leadership support following aggressive incidents. Many veterinarians relied on family, colleagues, or friends rather than mental health professionals for support. The authors conclude that veterinary organizations, educational institutions, and employers should implement comprehensive aggression prevention policies, provide de-escalation training beginning in veterinary school, strengthen leadership accountability, and improve access to mental health resources. These measures are essential to protect veterinarians, improve workplace safety, and help retain professionals in a field already facing significant workforce shortages.

Kogan, L. R., & Rishniw, M. (2026). Client-perpetrated aggression in veterinary practice: prevalence, psychological impact, and institutional response. American Journal of Veterinary Research https://doi.org/10.2460/ajvr.26.03.0121

Bottom line — Poor training aggravates the situation.

Librella Safety Update

Bedinvetmab (Librela/Beransa) is a monoclonal antibody that targets nerve growth factor (NGF) to relieve pain associated with canine osteoarthritis. By blocking NGF, the drug reduces pain signaling and has demonstrated high levels of clinician satisfaction because many dogs experience improved mobility and comfort. However, this review argues that NGF has essential biological functions beyond pain transmission, including maintaining bone remodeling, cartilage repair, and joint stability. Suppressing NGF may therefore interfere with normal joint homeostasis and contribute to rapidly progressive osteoarthritis (RPOA), a severe condition characterized by accelerated joint destruction, bone loss, instability, and fractures.  

The authors compare canine experience with human clinical trials of anti-NGF therapies. In people, similar drugs were ultimately denied regulatory approval after studies linked them to increased rates of RPOA and joint replacement surgery. Although preapproval studies of bedinvetmab in dogs did not identify this complication, they were relatively short and conducted in healthy young Beagles, making detection of delayed structural joint damage unlikely. Since the drug's commercial release, reports of severe musculoskeletal adverse events have accumulated, prompting investigations by regulatory agencies, including the FDA and European Medicines Agency.  

The review emphasizes that RPOA may initially be overlooked because effective pain relief can mask ongoing structural deterioration. Some affected dogs develop catastrophic changes not only in treated joints but also in previously unaffected joints within months of beginning therapy. Because radiographic changes often appear only after substantial damage has occurred, veterinarians are encouraged to perform careful baseline and follow-up orthopedic examinations, obtain diagnostic imaging when indicated, and promptly investigate any decline in clinical response. The authors also stress the importance of reporting suspected adverse drug events, obtaining informed owner consent before treatment, and supporting independent pharmacovigilance efforts. They conclude that while bedinvetmab remains an effective analgesic for many dogs, its long-term safety profile requires continued monitoring. Future research should clarify the incidence, mechanisms, and risk factors for RPOA so clinicians can better balance the benefits of pain relief against the possibility of irreversible joint damage.

von Pfeil, D. J. F., Adams, R. J., Clark, L., Dewey, C. W., Brunke, M. W., Garner, M., Lanz, O. I., Miller, N., Breshears, L., Déjardin, L. M., Armitage, A., Hayashi, K., & Vezzoni, A. (2026). Bedinvetmab (Librela/Beransa) in dogs raises safety concerns, including rapidly progressive osteoarthritis, and warrants vigilant adverse event reporting. Journal of the American Veterinary Medical Association https://doi.org/10.2460/javma.26.03.0170 

Bottom line — Vigilance is needed.

Stride Length And Cognition In Dogs

This longitudinal study investigated whether stride length is associated with cognitive decline in aging companion dogs. Researchers evaluated 88 senior and geriatric client-owned dogs enrolled in the Longitudinal Study of Canine Neuroaging. Dogs walked along a standardized 5-meter walkway while video recordings were used to measure stride length. To account for differences in body size, stride length was adjusted for each dog's height. Cognitive function was assessed using the owner-completed Canine Dementia Scale (CADES), while pain related to osteoarthritis was measured using the Canine Brief Pain Inventory (CBPI).  

The investigators found that height adjustment greatly reduced the influence of body size on stride length, making comparisons between breeds more reliable. Thoracic limb stride length declined significantly with advancing age, whereas pelvic limb stride length showed no consistent age-related changes. More importantly, dogs with higher CADES scores, indicating greater cognitive impairment, consistently had shorter thoracic limb stride lengths. This relationship remained significant even after accounting for age and pain, suggesting that reduced stride length reflects cognitive decline rather than simply the effects of aging or arthritis. In contrast, gait speed alone was not independently associated with cognitive impairment when stride length was included in the statistical models.  

The study also demonstrated excellent intra-observer and interobserver reliability for stride length measurements, indicating that this technique can be performed consistently by different evaluators. The authors suggest that thoracic limb stride length may serve as an objective and practical marker of functional decline in older dogs because it captures aspects of motor planning and neurological control that are affected by cognitive dysfunction. Since stride length can be measured using a simple video recording during a brief walking assessment, it has potential for routine clinical use. 

Overall, the findings indicate that shortened thoracic limb stride length is associated with cognitive decline in aging dogs independent of age and pain. Incorporating stride length assessment into routine geriatric examinations may improve the early detection and monitoring of canine cognitive dysfunction, complement owner questionnaires, and help veterinarians better evaluate quality of life and disease progression in senior dogs.

Rafatpanah Baigi S, Stywall A, Yang CC, Mondino A, Fefer G, Panek WK, Simon KE, Case BC, Gruen ME and Olby NJ (2026) Thoracic limb stride length is associated with cognitive impairment in aging dogs. Front. Vet. Sci. 13:1814017. doi: 10.3389/fvets.2026.1814017 

Bottom line — Short stride length is associated with cognitive problems in dogs.

Just putting things in perspective …