Identification and possible pathogenesis of bedinvetmab-associated adverse joint events

Bedinvetmab (Librela; Zoetis), an anti-nerve growth factor monoclonal antibody, is widely used for analgesia in canine osteoarthritis and is generally regarded as safe. However, emerging clinical experience and pharmacovigilance data indicate rare but clinically significant adverse joint events. This article describes and characterises atypical musculoskeletal adverse effects observed in dogs treated with bedinvetmab, drawing on referral caseload experience and comparative human anti-nerve growth factor data. Two principal patterns are identified: (1) rapidly progressive joint destruction resembling rapid progressive osteoarthritis; and (2) a more insidious syndrome characterised by extensive periarticular heterotopic mineralisation, exostoses and chondro-osseous metaplasia, termed anti-nerve growth factor-induced insidious periarticular mineralisation. These changes may progress despite effective analgesia, delaying recognition and leading to severe joint compromise. Proposed mechanisms include altered joint loading, disruption of nerve growth factor mediated tissue homeostasis and impaired mesenchymal stem cell-driven repair. The article emphasises the importance of baseline and follow-up imaging, careful monitoring of clinical response and reporting of suspected adverse events. Improved awareness is essential to refine diagnosis, management and pharmacovigilance of these emerging conditions.