Management strategies for improving the tolerability of interferons in the treatment of multiple sclerosis.

Interferon beta therapies for multiple sclerosis (MS) are well tolerated during long-term use, but the first year of treatment is a critical risk period for nonadherence and discontinuation. Some of the most common reasons for discontinuation include adverse effects (including flu-like symptoms and injection site reactions). Minimizing the impact of adverse effects is crucial in helping patients adhere to their treatment regimens, and improving their chances of better health over the longer term. Using a titration scheme to initiate therapy improves tolerability and concomitant prophylactic therapy, including non-steroidal anti-inflammatory drugs, reduces flu-like symptoms and discomfort associated with injection. Autoinjectors are also useful in improving the tolerability and consistency of injections. The support of the clinical MS team, particularly the specialist nurse, is vital to ensure adherence to treatment and, ultimately, to optimize efficacy. Good injection technique can reduce injection site reactions and injection site pain, and nurse specialists are well placed to teach new patients how to self-administer their therapy, review their injection techniques, and help the patient to stay motivated and adherent to treatment in the long term.