Injections Available for MS

Today I will begin a brief overview of the treatments for MS since a few people have asked for this and it is MS Awareness Week after all.  Anyone affected by MS should take the time to educate themselves about all aspects of this disease, whether you are the patient or you are a loved one.  There is a ton of information online.  If you found this blog then you most certainly can navigate the web and in today’s day and age there is no excuse for being uninformed.  The National MS Society’s website has a great brochure you can download that outlines all the treatments available today.  There are plenty of other places where you can find this information as well, including the pharmaceutical websites.  If symptoms are preventing you from effectively accessing this information on a computer, you can always call your local chapter of the National MS Society at 1.800.FIGHT.MS.

Let’s get started!  We’ve got 5 injected medications, 2 oral medications, and 2 intravenous (IV) medications.  Since the oral and IV medications are fairly new I want to learn about them in more depth and share more detailed information about them.  In the interest of space, I’ll just cover the 5 injectables today and then in future blogs we can learn about the newer drugs together.  

INJECTIONS

Avonex is an interferon that was made by Biogen Idec in 1996.  It is an intramuscular injection which means the syringe (needle) is longer so that you inject into the muscle tissue.  Avonex is generally taken once a week.  This is used primarily for Relapsing Remitting MS (RRMS) to slow progression and reduce the number and severity of exacerbations.  The most common side effect is flu-like symptoms following the injection.  I was lucky enough to experience these wonderful flu-like symptoms every week for five years!  Ick!  The doctors kept telling me that it would improve because apparently, for many people, this side effect does get better the longer you are on Avonex.  That didn’t happen for me, and to be quite honest, I feel that “flu-like” is an understatement.  I felt like I had the worst flu imaginable every single week and was so happy when I finally got off the drug.  I must say though that it did work really well for me when I first started it and I am glad I went on this drug.

Betaseron is another interferon that is injected every other day.  I realize now that it might helpful to define these chemicals, like interferon, but there isn’t space in this particular blog for that, so I will be sure to define the chemical makeup of some of these drugs in the future.  Betaseron is a subcutaneous injection which means it’s just under the skin and a much shorter needle (you might hear a nurse or doctor refer to this as “subcue”).  This gets injected into your fat layer.  Betaseron was made by Bayer HealthCare Pharmaceuticals and hit the market in 1993.  This is also to treat RRMS.  The most common side effect with Betaseron is also flu-like symptoms that are said to improve over time.  Additionally shot site reactions can be a common side effect…  Which reminds me!  We’ll have to have a blog just on prepping tips for injections to help reduce site reactions!  Nine years of injections taught me a lot and I’m happy to share!

Copaxone was made by Teva Pharmaceuticals in 1996 and is a glatiramer acetate (don’t worry about that for now, I’ll also define that another time).  This is a daily subcutaneous injection, so again, just under the skin, with the most common side effect being shot site reactions.  Copaxone is used to treat RRMS and was my first method of treatment after my diagnosis.  I injected myself with Copaxone for five years and, because it was daily and I had to rotate injection sites, I was covered with red golf balls on my thighs, hips, and stomach.  Throughout middle school and high school my friends were always super sensitive to not bump me in any of those areas.  It was like everyone, especially my family, learned to maintain a safe distance around my invisible protective “shot site” bubble.  As much as I hated the daily injections, I really loved this drug.  It kept me pretty stable for many years.  Toward the end of five years on it I began getting very sick.  My symptoms were worsening and I wasn’t seeing any improvement even with lots of rest and stress reduction.  My “Superbowl Health Care Team” made a group decision to try a new method of attack which is when I switched to interferon.  

Extavia is sort of a combination of the drugs mentioned so far which we call the ABC drugs (Avonex, Betaseron, Copaxone).  It’s an interferon like Avonex, Betaseron, and Rebif; is every other day like Betaseron; and is subcutaneous like Copaxone and Betaseron.  It shares a little bit of everything.  Extavia became available to patients in 2009 by Novartis Pharmaceuticals.  Extavia’s most common side effects are also flu-like symptoms which lessen over time, and injection site reactions.  It is also used to treat RRMS by reducing frequency of exacerbations.  I don’t know enough about this but my understanding is that Extavia in some ways is considered identical to Betaseron and therefore has the same warnings and side effects.  

Rebif is yet another interferon that is also subcutaneous and administered three times a week.  Rebif was brought to us by EMD Serono & Pfizer in 2002 and is also intended for RRMS.  Again with this interferon we are looking at flu-like symptoms that lessen with time for many people and shot site reactions as the common side effects.  

Each of these medications has its own set of warnings and risks attached to it.  It is very important that each patient read all the warnings when choosing a medication.  Sometimes history of depression or liver problems can become a huge factor in choosing your Disease Modifying Therapy.  

It is also important to note that some people seem to develop what we call “neutralizing antibodies” to interferons.  These antibodies essentially make you immune to the treatment, rendering it ineffective.  Testing for antibodies can be a great tool for assessing how you’re doing with your treatment.   If the injection you’re on is one of the interferons, you can test for neutralizing antibodies to determine if you should maintain your current treatment or make a change.  

I hope this was helpful for those who requested it.  It is only a brief summary.   More extensive information can be found online and I encourage you to research further if you are considering any of these medications. 

Infusions and oral medications coming soon to a blogpost near you!

   

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