THERAPEUTICS

Brands

• Avonex (1a), Rebif (1a), CinnoVex (1a), Plegridy (1a), Betaseron (1b), Extavia (1b)

Generic?

• No

Class

• Immunomodulator

Commonly Prescribed for

(FDA approved in bold)

• Reduction of relapses in patients with relapsing forms of multiple sclerosis (MS) (relapsing-remitting [RRMS] or secondary progressive with relapses)

• Clinically isolated syndromes (CIS)

How the Drug Works

• By modifying the immune processes believed responsible in part for the development of MS. Interferon-β (INFβ) has antiviral and immunomodulatory activities. Produces multiple gene products and markers, including β2-microglobulin, which affect immune function

• It may promote the nerve growth factor for regeneration

How Long Until It Works

• At least 6 months

If It Works

• Continue to use if effective. Monitor AEs

If It Doesn't Work

• Repeat brain MRI, check for neutralizing antibodies, reconsider the diagnosis of relapsing MS, and consider changing to another disease-modifying agent, such as natalizumab, glatiramer, or other newer agents depending on the clinical situation

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Acute attacks are often treated with glucocorticoids, especially if there is functional impairment such as vision loss, weakness, or cerebellar symptoms

• Treat common clinical symptoms in MS with appropriate medication for spasticity (baclofen, tizanidine), neuropathic pain, and fatigue (modafinil)

• For patients with relapsing MS refractory to INFβ, as measured by clinical outcome and MRI accumulation of lesions, consider changing to other agents, such as natalizumab, fingolimod, or other newer agents depending on the clinical situation

• Combined use of INFβ and natalizumab is more effective but may increase the risk of progressive multifocal leukoencephalopathy

Tests

• None required

ADVERSE EFFECTS (AEs)

How the Drug Causes AEs

• Except for injection site reactions, AEs are from INF component of drug

Notable AEs

• Flu-like symptoms, fatigue, weakness or myalgias, chest pain, and headache can occur within hours after starting drug. Long-term use may cause elevation of hepatic enzymes, leukopenia, photosensitivity, or injection site necrosis. Monitor for depression or worsening of existing psychiatric disorders