Grapiprant vs. NSAIDs - More hype than hero?

RE: Grapiprant vs. NSAIDs - More hype than hero?

Evelyn Barbour-Hill — Mon, 02 Sep 2019 19:00:09 GMT

[quote user="Andreas Ege"]we don't need another pain killer thats better than placebo.[/quote]

Why not? The more the merrier.

[quote user="Andreas Ege"]Unfortunately, standard for licensing both himan and veterinary drugs is exactly that.[/quote]

It gets a licence if it works. What's wrong with that? It's for clinical researchers and you to work out which works better (if either), not to mention which is cheaper, which is the more acceptable and so on.

RE: Grapiprant vs. NSAIDs - More hype than hero?

Andreas Ege — Mon, 02 Sep 2019 18:37:29 GMT

[quote user="robloxley"]It suprises me you can get a license by testing a drug compared to placebo rather than against 'standard of care' eg meloxicam or carprofen?[/quote]

As Ben Goldacre said: we don't need another pain killer thats better than placebo. We need one, that's better than the existing. (or similar

Unfortunately, standard for licensing both himan and veterinary drugs is exactly that.

But of course, the regulator knows what's best. Never said for whom, though.

RE: Grapiprant vs. NSAIDs - More hype than hero?

Thomas Johnson — Mon, 02 Sep 2019 17:08:50 GMT

[quote user="Mike Dale"]So far, whenever I have prescribed Galliprant in place of another NSAID for ongoing OA, the response has been that it has been more effective. By contrast, a colleague has just told me that the first few dogs she put on Galliprant had G-I upsets; which is not supposed to happen.[/quote]

The data sheet does say that you can get transient vomiting and soft faeces when starting Galliprant, we were advised by the rep that you should keep giving it and the GI signs will resolve in 24-48hrs.

RE: Grapiprant vs. NSAIDs - More hype than hero?

Mike Dale — Mon, 02 Sep 2019 16:48:31 GMT

So far, whenever I have prescribed Galliprant in place of another NSAID for ongoing OA, the response has been that it has been more effective. By contrast, a colleague has just told me that the first few dogs she put on Galliprant had G-I upsets; which is not supposed to happen.

RE: Grapiprant vs. NSAIDs - More hype than hero?

jane alexander — Mon, 02 Sep 2019 09:11:51 GMT

and for an acute 'injury', rather than ongoing OA management.

are we surprised?

RE: Grapiprant vs. NSAIDs - More hype than hero?

Rob Loxley — Mon, 02 Sep 2019 08:50:44 GMT

[quote user="Beats"]

From a trial on osteoarthritis cases:

"Grapiprant treatment improved pain compared to placebo on day 28 (48.1 and 31.3% treatment successes respectively...)"

That's hardly hype...

[/quote]

It suprises me you can get a license by testing a drug compared to placebo rather than against 'standard of care' eg meloxicam or carprofen? Given the improvement in the placebo group, how much of what is reported in the galliprant group is just reversion-to-mean?

RE: Grapiprant vs. NSAIDs - More hype than hero?

Francisco Gomez — Fri, 30 Aug 2019 22:30:58 GMT

RE: Grapiprant vs. NSAIDs - More hype than hero?

David Mills — Fri, 30 Aug 2019 22:27:06 GMT

[quote user="Beats"]

[quote user="David Mills"]I haven't read it, but I assume this passed "ethical approval" in America?[/quote]

France.

"The study was favourably assessed by the Avogadro LS Animal Ethics Committee and authorized by Merial (now part of Boehringer-Ingelheim) Ethical Committee."

[/quote]

Ah yes, France. Famous for progressive attitudes towards animal welfare.

RE: Grapiprant vs. NSAIDs - More hype than hero?

Beats — Fri, 30 Aug 2019 22:12:17 GMT

[quote user="David Mills"]I haven't read it, but I assume this passed "ethical approval" in America?[/quote]

France.

"The study was favourably assessed by the Avogadro LS Animal Ethics Committee and authorized by Merial (now part of Boehringer-Ingelheim) Ethical Committee."

RE: Grapiprant vs. NSAIDs - More hype than hero?

David Mills — Fri, 30 Aug 2019 22:09:20 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Andreas Ege"]

So, while interesting, it's not actually robust evidence and I would take it with a very big grain of salt...

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edit: after a bit more of a browse: "Based on the mode of action, which could be more progressive for grapiprant than for firocoxib, this model of acute pain control could not be sufficient to show pain and anti-inflammatory control under chronic conditions like osteoarthrosis."

Even the authors acknowledge, for practical purpose in day to day practice this study isn't suited.

[/quote]

So, as far as I can see, thirty-six dogs had pain induced by injection of urate crystals into joints in a completely useless experiment. I thought respectable journals rejected this sort of paper nowadays.

[/quote]

I haven't read it, but I assume this passed "ethical approval" in America?

RE: Grapiprant vs. NSAIDs - More hype than hero?

Beats — Fri, 30 Aug 2019 21:46:49 GMT

I don't think it looks too hyped.

From a trial on osteoarthritis cases:

"Grapiprant treatment improved pain compared to placebo on day 28 (48.1 and 31.3% treatment successes respectively...)"

That's hardly hype...

Would have to be much safer than meloxicam for me to choose it in preference... I'm happy to wait a few years to find out...

RE: Grapiprant vs. NSAIDs - More hype than hero?

Evelyn Barbour-Hill — Fri, 30 Aug 2019 20:03:14 GMT

[quote user="Andreas Ege"]

So, while interesting, it's not actually robust evidence and I would take it with a very big grain of salt...

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Even the authors acknowledge, for practical purpose in day to day practice this study isn't suited.

[/quote]

RE: Grapiprant vs. NSAIDs - More hype than hero?

Andreas Ege — Fri, 30 Aug 2019 19:27:15 GMT

Will be interesting to read, only gave it a quick browse so far.

The first warning flag comes up reading the authors list, though: the lead author works for Boehringer Ingelheim...

The next warning flag is the question how much the approach used tells us about real patients: they gave the meds before the onset of pain. I'm not seeing a lot of dogs where I start treating arthritis before they are showing signs of pain, and they were only treating them once following up for 24 hours and the study was only assessor-blinded.

So, while interesting, it's not actually robust evidence and I would take it with a very big grain of salt...

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Even the authors acknowledge, for practical purpose in day to day practice this study isn't suited.

"More hype than hero?" Well, quite simply, for acute chemical-inflammatory pain, probably yes. For anything else, who knows yet.