Mary L Filipi1, Jill Beavin1, Raquel T Brillante1, Kathleen Costello1, Gail C Hartley1, Kay Hartley1, Marie Namey1, Shirley O'Leary1, Gina Remington1. 1. College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA (MLF); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Forget-Me-Not Home Memory Care, Raleigh, NC, USA) (JB); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Rush Multiple Sclerosis Center, Chicago, IL, USA) (RTB); Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA (KC); Acadia Neurology Center, Acadia, CA, USA (GCH); Providence Multiple Sclerosis Center, Providence St. Vincent Medical Center, Portland, OR, USA (KH); Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, OH, USA (MN); Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA (substantial portion of contributions made while employed at Texas Neurology, Dallas, TX, USA) (SO); and Clinical Center for Multiple Sclerosis, Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA (GR). Kay Hartley is now with Providence Home Health, Portland, OR, USA.
Abstract
BACKGROUND: Several interferon beta (IFNβ) formulations are approved for first-line use as disease-modifying therapies to treat patients with multiple sclerosis (MS). Systemic post-injection reactions, often termed flu-like symptoms (FLS), occur in approximately half of all patients treated with IFNβs and can affect adherence to therapy. These symptoms, which include pyrexia, chills, malaise, myalgia, and headaches, usually resolve within 24 hours or persist intermittently following each injection. Because FLS, which usually occur early in the treatment course and diminish over time, are a primary cause of nonadherence to IFNβ therapy, it is important to employ strategies that can attenuate these side effects. METHODS: To identify interventions effective in limiting FLS, a panel of United States-based nurses with expertise in MS patient care was convened and a literature review completed. RESULTS: Panel consensus was reached on specific interventions that can attenuate FLS. These prevention and mitigation strategies include dose titration, analgesia, and optimal injection timing, as well as other techniques that panel members have found useful in their clinical practice experience. CONCLUSIONS: These measures, in addition to effective patient education, will help to reduce the incidence of FLS secondary to IFNβ therapy, improve patient medication adherence, and positively affect long-term clinical outcomes.
BACKGROUND: Several interferon beta (IFNβ) formulations are approved for first-line use as disease-modifying therapies to treat patients with multiple sclerosis (MS). Systemic post-injection reactions, often termed flu-like symptoms (FLS), occur in approximately half of all patients treated with IFNβs and can affect adherence to therapy. These symptoms, which include pyrexia, chills, malaise, myalgia, and headaches, usually resolve within 24 hours or persist intermittently following each injection. Because FLS, which usually occur early in the treatment course and diminish over time, are a primary cause of nonadherence to IFNβ therapy, it is important to employ strategies that can attenuate these side effects. METHODS: To identify interventions effective in limiting FLS, a panel of United States-based nurses with expertise in MSpatient care was convened and a literature review completed. RESULTS: Panel consensus was reached on specific interventions that can attenuate FLS. These prevention and mitigation strategies include dose titration, analgesia, and optimal injection timing, as well as other techniques that panel members have found useful in their clinical practice experience. CONCLUSIONS: These measures, in addition to effective patient education, will help to reduce the incidence of FLS secondary to IFNβ therapy, improve patient medication adherence, and positively affect long-term clinical outcomes.
Authors: V Devonshire; Y Lapierre; R Macdonell; C Ramo-Tello; F Patti; P Fontoura; L Suchet; R Hyde; I Balla; E M Frohman; B C Kieseier Journal: Eur J Neurol Date: 2011-01 Impact factor: 6.089
Authors: Katherine Treadaway; Gary Cutter; Amber Salter; Sharon Lynch; James Simsarian; John Corboy; Douglas Jeffery; Bruce Cohen; Ken Mankowski; Joseph Guarnaccia; Lawrence Schaeffer; Roy Kanter; David Brandes; Charles Kaufman; David Duncan; Ellen Marder; Arthur Allen; John Harney; Joanna Cooper; Douglas Woo; Olaf Stüve; Michael Racke; Elliot M Frohman Journal: J Neurol Date: 2009-04-27 Impact factor: 4.849
Authors: R Zivadinov; L Locatelli; D Cookfair; B Srinivasaraghavan; A Bertolotto; M Ukmar; A Bratina; C Maggiore; A Bosco; A Grop; M Catalan; M Zorzon Journal: Mult Scler Date: 2007-02-09 Impact factor: 6.312
Authors: Stephanie C Steinberg; Richard J Faris; Cyril F Chang; Andrew Chan; Mark A Tankersley Journal: Clin Drug Investig Date: 2010 Impact factor: 2.859
Authors: L D Jacobs; D L Cookfair; R A Rudick; R M Herndon; J R Richert; A M Salazar; J S Fischer; D E Goodkin; C V Granger; J H Simon; J J Alam; D M Bartoszak; D N Bourdette; J Braiman; C M Brownscheidle; M E Coats; S L Cohan; D S Dougherty; R P Kinkel; M K Mass; F E Munschauer; R L Priore; P M Pullicino; B J Scherokman; R H Whitham Journal: Ann Neurol Date: 1996-03 Impact factor: 10.422
Authors: David W Brandes; Kim Bigley; William Hornstein; Hart Cohen; William Au; Richard Shubin Journal: Curr Med Res Opin Date: 2007-07 Impact factor: 2.580
Authors: Robert T Naismith; Barry Hendin; Sibyl Wray; DeRen Huang; Fiorenza Gaudenzi; Qunming Dong; Bjørn Sperling; Monica Mann; Brian Werneburg Journal: Mult Scler J Exp Transl Clin Date: 2019-01-30
Authors: Stanley L Cohan; Barry A Hendin; Anthony T Reder; Kyle Smoot; Robin Avila; Jason P Mendoza; Bianca Weinstock-Guttman Journal: CNS Drugs Date: 2021-07-06 Impact factor: 5.749
Authors: Juan José Nieto-Fontarigo; Sofia Tillgren; Samuel Cerps; Asger Sverrild; Morten Hvidtfeldt; Sangeetha Ramu; Mandy Menzel; Adam Frederik Sander; Celeste Porsbjerg; Lena Uller Journal: Front Immunol Date: 2021-12-07 Impact factor: 7.561