Management of patients receiving interferon beta-1b for multiple sclerosis

Abstract

Results of a double-blind, placebo-controlled study in ambulatory patients with relapsing-remitting MS showed that interferon beta-1b reduced the rate of exacerbations by one-third compared with placebo and limited new disease activity in the brain as evidenced by MRI. Interferon beta-1b, administered subcutaneously at a dosage of 0.25 mg (8 million IU) every other day is indicated for the treatment of ambulatory patients with relapsing-remitting MS. Interferon beta-1b may help a wider range of patients, but it should be prescribed only for patients with a diagnosis of clinically definite or laboratory-supported definite MS. The decision to treat a patient with interferon beta-1b should be individualized; that is, based on each patient's clinical presentation and course of MS. The most common adverse effects include (1) injection-site reactions and (2) flu-like symptoms, which are generally manageable and usually abate after the first few months of treatment. Spasticity may increase. Patients with severe depression or suicidal ideation should be monitored carefully, and symptomatic treatment should be pursued. Interferon beta-1b is contraindicated in pregnant and nursing women. Interferon beta-1b is effective in reducing the progression of total disease burden as seen on MRI in patients with MS. Its use is relatively straightforward and generally does not require alteration in the symptomatic treatment of MS. Patient education and support remain the mainstays of maintaining compliance through the early phases of therapy.

Psychiatric Issues in Multiple Sclerosis

“…[30] Nonetheless, given the high prevalence of depression among persons with MS, expert panels have recommended that patients should be educated about depression and complete a measure of depression severity at regular intervals during the course of IFN treatment. [31] There have been no reports to date of psychiatric side effects associated with two newer pharmacotherapies for MS. Mitoxantrone (Novantrone), an immunosuppressant, is approved for treatment of secondary progressive, progressive-relapsing, and worsening relapsingremitting MS. Natalizumab (Tysabri) is a monoclonal antibody against integrin-α4 that was approved by the FDA in 2006 for treatment of patients with relapsing forms of MS who have not responded to or are unable to tolerate the other treatments of MS. Because natalizumab increases the risk of progressive multifocal leukoencephalopathy, this medication is available only through a special restricted distribution program and not widely used.…”

Recent progress in the diagnosis and treatment of multiple sclerosis

“…The most common adverse effects are flu-like symptoms and injection site reactions. 36 The flu-like symptoms include fever, chills, myalgia, headache and malaise. The increase in body temperature may transiently aggravate the symptoms and signs of MS by reversibly increasing conduction block in previously demyelinated fibres.…”

“…It is unclear whether it aggravates depression and increases the frequency of suicide attempts, but active severe depression should be regarded as a contraindication to the use of interferon beta-1b. 36 Interferon beta-1b is also contraindicated in pregnant women, in those who are actively attempting to become pregnant and in those who are breastfeeding.…”

Injectable Multiple Sclerosis Medications

“…14 Not surprisingly, skin reactions are less common and appear to be less likely to cause discontinuation in users of the IM injectable therapy. [1][2][3][4][5]14,15 Injection-site reactions as a side effect of injectable DMTs have important implications for both discontinuation and adherence. However, few large patient surveys have reported effective strategies for managing ISRs.…”