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| Multiple Sclerosis Disease modifying agents |
| Overview |
 | In relapsing remitting MS patients, all the disease modifying therapies
seem to
 | reduce relapse rate & severity
of relapses |
| slow the rate of progression |
| reduce
MRI enhancing lesions |
|
| Preparations:
| Monoclonal antibody: Tysabri®, currently
taken off the market. |
| Interferon beta 1a: Avonex, Rebif |
| Interferon beta 1b: Betaseron |
| Glatiramer Acetate: Copaxone |
|
| Side effects of interferon beta-1b, beta-1a:
| Flu-like symptoms on the day following the injection. |
| Ways to reduce the side effect:
 | take the injection before bedtime |
| use ibuprofen or acetaminophen prior to the injection and the next day |
| gradually escalate to full dosage over several weeks. |
|
| The reactions tend to wane over several months. |
| Copaxone (glatiramer acetate) does not produce
a flu-like symptom and there is no need to monitor blood tests. |
|
| Antibody production:
| The rate of NAb production, however,
is probably less with IFNß-1a than with IFNß-1b
treatment. |
| The biologic effect of NAb is
uncertain. |
|
| Mitozantrone
(Novantrone): has been
approved by the FDA for use in secondary progressive multiple
sclerosis to slow down the progress of the disease. |
|
| Tysabri (Natalizumab) |
|
|
| Avonex (Interferon beta 1a) |
| Formulations: Each Vial: 33 mcg/ml |
| Dose: 30 mcg IM once weekly |
| Pregnancy Category C |
| Side effect: Flu like symptom 61%, injection site reactions, myalgias,
fever, chills, headache, depression, bronchospasm, anxiety |
| More information from Biogen |
|
| Betaseron (Interferon beta 1b) |
| Dose: 0.25 mg qod sq, rotate sites: anterior thigh,
buttock, abdomen. Premedicate with Tylenol 650 mg before and after. |
| Pregnancy Category C |
| Side effects: flu like symptom in 1st 2 wk, depression, injection site
reaction, neutropenia, increased liver enzymes. Monitor CBC, LFT every 3
months. |
| More information -
Berlex Lab |
|
| Copaxone (glatiramer acetate) |
| Dose: 20 mg/vial, 20 mg sq daily |
| Pregnancy Class B |
| Side effects: injection site reactions, immediate postinjection reaction
10%, transient chest pain (26%), anxiety, arthralgia, asthenia, vasodilatation, hypertonia. |
| “post-injection reaction”: Patient should be warned of this peculiar reaction. This
may occurr within a few moments of an injection, characterized by tightness in the chest and flushing of the face, possibly accompanied by palpitations, shortness of breath,
feeling of anxiety. The reaction has never had serious consequences and is self-limited, generally resolving in about 10-20 minutes.
It occurred approximately every 2000 injections. |
| www.copaxone.com |
|
| Rebif (Interferon beta 1a) |
| Approved by US FDA March 2002 |
| Dose: start at 8.8 mcg SC 3 times/ week (TIW),
increase over a 4 week period to 44 mcg TIW. |
| Supplied in 0.5 mL prefilled syringes, 22 mcg and 44
mcg syringes. Needs to be stored in refrigerator. Do not freeze. |
| Pregnancy Category: C |
| Most common severe side effect: depression
and suicidal ideation |
| Adverse reactions: injection side reactions, flu like symptoms,
asthenia, pyrexia, chills, myalgia, headache, arthralgia, elevated liver
enzymes and hematologic abnormalities. |
| www.rebif.com |
|
| Novantrone
(Mitozantrone) |
| Approved by the FDA for use in secondary progressive multiple
sclerosis to slow down the progress of the disease. |
|
| Further reading |
|
|
Multiple Sclerosis Info Center
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