Injectable Treatments for Multiple Sclerosis
There are several injectable therapies designed to treat the underlying course of multiple sclerosis (MS). The most common injectable MS treatments are interferon beta-1a, interferon beta-1b or glatiramer acetate. Interferon is a substance naturally produced in the body and believed to modify the body’s immune response. Glatiramer acetate is a synthetic compound made up of four amino acids, which are the building blocks of proteins. While these MS treatments are all given by injection, they are not the same types of injections.
What are Subcutaneous and Intramuscular Injections?
Rebif® (interferon beta-1a), Betaseron® (interferon beta-1b), and Copaxone® (glatiramer acetate) are all medicines administered by subcutaneous or under-the-skin injections. These therapies use a needle to deliver medications into tissue just under the skin.
AVONEX® (Interferon beta-1a) is an intramuscular (IM) injection. AVONEX is given directly into the muscle tissue of the body, such as the thigh or upper arm. People taking IM injections may have fewer injection site reactions than those who inject under the skin. In clinical studies AVONEX showed a low incidence (3%) of injection site reactions.
A common myth about IM injections is that they will be more painful because they require a longer needle. However, the pain of injections mostly comes from piercing the top layers of your skin, where pain receptors are located. So your level of pain should be similar whether the injection is under the skin or into the muscle.
How Often Do You Need Injections?
Subcutaneous MS treatments require three or more injections a week. AVONEX, the intramuscular therapy, requires one injection per week. Staying on therapy is important for managing your multiple sclerosis. So you’ll want to find a treatment that’s convenient for you. MS treatments that need to be given less frequently may be easiest to continue over time. Infusion therapies have different schedules than injectable therapies.
Effectiveness and Neutralizing Antibodies
Imagine being on an MS treatment for some time, and it gradually stops working for you. Unfortunately, that can and does happen. Some people on MS treatment produce “neutralizing antibodies.” Antibodies are part of the immune system that responds to foreign substances like viruses and bacteria. Sometimes, people develop antibodies to their MS treatment. They’re called neutralizing antibodies because they may interfere with or neutralize your MS treatment, making it less effective over time. Neutralizing antibodies typically develop 12 to 18 months after the start of treatment. It’s important to consider this when deciding on an MS treatment.
The Impact of Neutralizing Antibodies
While the clinical significance of neutralizing antibodies to MS treatments is not fully understood, studies show that they may have an impact on the effectiveness of a medication. People who maintain a high level of neutralizing antibodies over time, seem to have a reduced level of effectiveness in their medication and a higher rate of relapse, compared with those who do not have the antibodies.
Talk to your doctor about which interferon therapies will minimize your risk for developing neutralizing antibodies. You may want to ask your doctor about AVONEX® (interferon beta-1a). In recent studies, only 5% of people taking AVONEX had detectable levels of neutralizing antibodies after 1 year. After 18 months in another study, AVONEX showed a low risk (2%) of developing neutralizing antibodies.
The clinical significance of neutralizing antibodies to interferon therapy is not fully understood.
Important Safety Information About AVONEX
Some people have had seizures while taking AVONEX. Some interferons, including AVONEX, make people feel sad. If you are taking AVONEX and feel unusually sad or have had a seizure, you should call your doctor.
A few people have developed liver injury, sever allergic reactions, a drop in their red or white blood cells or changes in their thyroid function while taking AVONEX. Your doctor may ask you to have regular blood test to monitor these functions. If your skin or the whites of your eyes become yellow or if you are bruising easily, call your doctor immediately.
If you become pregnant while taking AVONEX, you should stop taking AVONEX immediately and tell your doctor.
The most common side effects of people taking AVONEX include flu-like symptoms (fever, chills sweating, muscle aches and tiredness.)
Important Safety Information About Copaxone
COPAXONE®(glatiramer acetate injection) is indicated for the reduction of relapses in relapsing-remitting multiple sclerosis.
The most common side effects of COPAXONE® are redness, pain, swelling, itching, or a lump at the site of injection, flushing, chest pain, weakness, infection, pain, nausea, joint pain, anxiety, and muscle stiffness. These reactions are usually mild and seldom require professional treatment. Be sure to tell your doctor about any side effects.
Some patients report a short-term reaction right after injecting COPAXONE®. This reaction can involve flushing (feeling of warmth and/or redness), chest tightness or pain with heart palpitations, anxiety, and trouble breathing. These symptoms generally appear within minutes of an injection, last about 15 minutes, and go away by themselves without further problems.
After you inject COPAXONE®, call your doctor right away if you develop hives, skin rash with irritation, dizziness, sweating, chest pain, trouble breathing, severe pain at the injection site or other uncomfortable changes in your general health. Do not give yourself any more injections until your doctor tells you to begin again.
Important Safety Information About Rebif
Rebif is used to treat relapsing forms of MS to decrease the frequency of relapses and delay the occurrence of some of the physical disability that is common in people with MS.
Before beginning treatment, patients should discuss with their doctor the potential benefits and risks associated with Rebif. Let your doctor know if you have a history of depression, seizures, liver disease, thyroid problems, and blood count or bleeding problems or if you have had previous allergic reactions to medications. Tell your doctor about all medicines you take, including prescription and non-prescription medicines, vitamins and herbal supplements. Rebif and other medicines may affect each other causing serious side effects. Talk to your doctor before you take any new medicines. Rebif is not recommended for women who are or plan to become pregnant.
Potential serious side effects of Rebif include depression, liver problems, risk to pregnancy, injection site problems and severe allergic reactions. Allergic reactions are rare and may be associated with difficulty breathing and loss of consciousness, which requires immediate medical attention. The most common side effects with Rebif are injection site reactions, flu-like symptoms (fever, chills, muscle aches, tiredness), depression, abdominal pain, increased liver enzymes, and blood cell count decreases. Let your doctor know immediately if you have any of these symptoms or feel sad, tired, hot or cold, experience hives, rashes, bruising, yellowing of the skin, or a change in body weight (gain or loss).
Important Safety Information About Betaseron
The most commonly reported adverse reactions are lymphopenia, injection site reaction, asthenia, flu-like symptom complex, headache, and pain. Betaseron should be used with caution in patients with depression. Injection site necrosis has been reported in 5% of patients in controlled trials. Patients should be advised of the importance of rotating injection sites. Female patients should be warned about the potential risk to pregnancy. Cases of anaphylaxis have been reported rarely.
Betaseron® is a registered trademark of Berlex Laboratories, Inc.
Rebif® is a registered trademark of Serono, Inc.
Copaxone® is a registered trademark of Teva Pharmaceutical Industries, Ltd.
