Monoclonal Antibody Medicines - Understanding the risks for pets
By Dr Edward Bassingthwaighte, Holistic Veterinarian
Monoclonal Antibody (mAb) ARTHRITIS Medications: Miracle Drugs, or a Risky Gamble for Your Dog?
In recent years a new medication for relieving arthritic pain has garnered attention as a ‘breakthrough treatment for osteoarthritis in dogs’. Approved by the Food and Drug Administration (FDA) in the United States, this monoclonal antibody offers a monthly injection designed to relieve pain. While many pet parents hope for a miracle solution for their furry companions, it’s crucial to delve into the potential risks associated with this medication (and all medications) before making an informed choice about using it or not with your dogs.
What are mAb arthritis medications?
They are monoclonal antibodies that specifically target a special (and very important) molecule in your dog’s body: nerve growth factor (NGF). By binding to NGF, it prevents this protein from attaching to its receptors in a range of cells and tissues. This has some efficacy in interrupting the transmission of pain signals from arthritis but can also interfere with or block a range of critically important processes throughout the body.
While this medication can lead to significant pain relief in some dogs, it’s important to understand that it blocks a protein with multiple essential functions throughout your dog’s body. Which carries a significant risk of doing harm or causing an adverse reaction.
Understanding Monoclonal Antibodies
Monoclonal antibodies have been a part of human medicine since 1988, successfully treating conditions such as cancer and autoimmune disorders. These artificially created antibodies are designed to mimic the immune system's ability to fight off disease, targeting specific molecules. However, I believe that there is a significant risk of them causing harm.
The monoclonal antibodies that these arthritis drugs are made of are not nature identical. They are artificially created, and apart from blocking NGF throughout the body, they may cause the immune system to react to them as a foreign substance, potentially triggering autoimmune disease.
How mAb Arthritis Drugs Work
While its primary claim is to alleviate pain from osteoarthritis, NGF plays several critical roles throughout the body. Beyond pain signaling, it is crucial for the growth, maintenance, and survival of nerve cells. It also regulates immune responses and helps in the development of certain white blood cells. It is an essential molecule for deep, important homeostatic, immune system, neurological, and inflammatory processes. By blocking NGF, these medications can interfere with these vital functions, which can lead to significant harm and injury (adverse reactions) - with all sorts of different kinds of side effects.
The Side Effects of mAb Arthritis Medications
There is a significant risk, likely quite a lot higher than that claimed by the company that markets this medication. See this website for a comprehensive deep dive into adverse reactions, the likely true risk (it increases with every monthly dose), and a half-life calculator so you can find out how long it will take for the drug to clear out of your dog’s body.
Listed side effects from the Canadian insert for this mAb arthritis medication include:
Injection site reactions: Swelling, pain, or discomfort.
Systemic disorders: Symptoms like lethargy, anorexia, and in severe cases, death.
Renal issues: Such as urinary incontinence or changes in urination patterns.
Gastrointestinal problems: Including diarrhea and vomiting.
Neurological effects: Ataxia, seizures, or changes in behavior.
In the U.S., common side effects noted include urinary tract infections, bacterial skin infections, and dermatitis. These reactions can be particularly concerning for elderly dogs or those already dealing with compromised health, as they may push an already fragile system over the edge.
One thing you need to be aware of is that the company that markets this drug does NOT list all of the potential side effects listed on the Canadian region product insert on the Australian, US regions etc. This means that your vet may not be aware of the risks.
Real-Life Experiences
While clinical data offers insight into potential side effects, anecdotal reports from pet parents provide a fuller picture of these medication’s impacts. Many parents in online forums and support groups have shared their experiences with the drug. Some dogs thrive, showing remarkable improvements in their quality of life, while others suffer with debilitating side effects.
Reported symptoms from concerned pet parents include:
- Increased thirst and urination - polydipsia + polyuria
- Lethargy and excessive drooling
- Changes in behavior, such as hiding or acting fearful
- Gastrointestinal distress like vomiting and diarrhea
- Neurological issues, including staggering or seizures, weakness, collapse in the hind end
The 7th most reported adverse reaction is death by euthenasia (1526 animals).
In these cases, the adverse effects can be so severe that they need euthanasia before the medication has had a chance to wear off (which takes a long time, up to 6-8 weeks or more). This stark reality highlights the importance of being fully informed about the potential risks before making a treatment decision.
The Importance of Monitoring
Given the mechanism of action of these medications, and the potential for side effects, careful monitoring is crucial. Many dogs may appear to benefit initially, feeling pain-free and more active.
However, increased activity can inadvertently lead to further joint damage if pet parents aren’t vigilant. Dogs may overexert themselves when they feel good, which could exacerbate underlying osteoarthritis.
It’s essential to manage activity levels and observe any behavioral changes following treatment. Pet parents should be prepared to discuss any concerns with their veterinarian to adjust treatment plans accordingly.
Alternatives to mAb Arthritis Medications
While these medications may seem like an attractive option, it would never be my first choice for treating arthritis in dogs. There are several safer alternatives worth considering:
Essential Fatty Acids: High doses of omega-3 fatty acids can help reduce inflammation and improve joint health.
Natural Supplements: Green-lipped mussel extract, turmeric, and rosehip have shown promise in managing arthritis symptoms without the associated risks of monoclonal antibodies.
Physical Therapy: Regular exercise, coupled with physical therapy, can greatly benefit dogs with arthritis, helping to maintain mobility and strength.
Acupuncture: This holistic approach can alleviate pain and improve overall well-being.
CBD Oil: Increasingly popular for its anti-inflammatory properties, CBD oil may offer a safer option for pain management.
Prescription pain relief drugs: there are a whole range of drugs that I consider to be safer, including Non-Steroidal Anti-inflammatories (NSAIDs) like meloxicam etc., atrophy infections, Panadol, low-dose ketamine injections, Gabapentin, etc., that I would use before considering these mAb medications
When to Consider mAb Arthritis Medication for your Dog?
In my professional opinion, mAb arthritis medications should only be considered when other treatment options have been exhausted, and the focus is on providing the best possible quality of life for your dog. It’s crucial to have an open conversation with your veterinarian about the pros and cons of these medications compared to other therapies. Remember, your vet may not have any idea about the true risks.
If other holistic approaches fail to provide relief and your dog’s quality of life is significantly impacted by arthritis pain, then it may be time to consider mAb’s cautiously. However, understanding the associated risks will help you make an informed decision that’s in the best interest of your pet.
Final Thoughts
While mAb arthritis medications can be a game-changer for some dogs, it is vital to approach this treatment with caution. The potential for serious side effects should not be taken lightly, especially in dogs that may already have compromised health.
As a responsible pet parent, do thorough research, consult with your veterinarian, and consider all available options before deciding on treatment. A balanced approach that prioritises your dog’s overall well-being will ensure that you’re making the best choice for your furry family member.
About the Author - Dr Edward Bassingthwaighte.
Dr Edward Bassingthwaighte is a holistic veterinarian, and a world-leading expert in silent pain in pets. Dr Edward is passionate about fresh raw whole foods for dogs. He is the founder of the Whole Energy Body Balance method- a profoundly healing bodywork modality for pet parents and pet wellness professionals to relieve silent pain, anxiety and trauma in pets. Join Dr Edward's free masterclass on silent pain in pets here.