II. Indications

  1. Multiple Sclerosis - Relapsing Forms
    1. Interferon has the longest use in MS than any of the other immunomodulators

III. Mechanism

  1. Interferon is an endogenous Cytokine (integral to inflammatory and immune responses)
    1. Released from Lymphocytes, Dendritic Cells, Macrophages, fibroblasts, Natural Killer Cells and T Cells
  2. Interferon is subdivided into three main types (alpha, beta, gamma)
    1. Alpha and beta Interferon both have Antiviral activity
    2. Synthesized alpha Interferon has primarily been used for Viral Hepatitis B and C infection, as well as cancer
    3. Synthesized beta Interferon has primarily been used to treat Multiple Sclerosis
  3. Interferon Beta is a type 1 Interferon, a Cytokine produced by fibroblasts
    1. Released in response to viral contact or DS-DNA
    2. Has Antiviral, antiproliferative and immunomodulator activity

IV. Medications

  1. Interferon Beta-1A
    1. Avonex 30 mcg vials or prefilled syringes
    2. Rebif Titration Kits, and 22 and 44 mcg prefilled syringes and autoinjectors
  2. Peginterferon Beta-1A
    1. Plegridy Starter Pack and 125 mcg pens and prefilled syringes

V. Dosing

  1. Avonex
    1. Target Dose: 30 mcg IM once weekly
    2. Start: 7.5 mcg IM weekly and increase dose by 7.5 mcg each week until at 30 mcg dose
      1. Titration allows for lower risk of flu-like symptoms
  2. Rebif
    1. Choose between 2 target doses
    2. Target 22 mcg SC three times weekly (same days each week, each dose 48 hours apart)
      1. Start 4.4 mcg SQ three times weekly for 2 weeks
      2. Next 11 mcg SQ three times weekly for 2 weeks,
      3. Next 22 mcg SQ three times weekly
    3. Target 44 mcg SC three times weekly (same days each week, each dose 48 hours apart)
      1. Start 8.8 mcg SQ three times weekly for 2 weeks
      2. Next 22 mcg SQ three times weekly for 2 weeks,
      3. Next 44 mcg SQ three times weekly
  3. Plegridy (Peginterferon Beta-1A)
    1. Day1: Start 63 mcg SQ
    2. Day 15: Increase to 94 mcg SQ
    3. Day 29: Increase to 125 mcg SQ
    4. Next: Continue 125 mcg SQ every 14 days
    5. Pretreat with Analgesics and Antihistamines to reduce flu-like reactions
    6. Increased drug levels and adverse reactions with renal Impairment

VI. Adverse Effects

  1. Allergic Reactions (including Anaphylaxis)
  2. Local injection site inflammation
  3. Influenza-like symptoms (decreases after first 3 months)
  4. Mental health adverse effects
    1. Exacerbation of depressed mood (including increased Suicidality)
    2. Psychosis
  5. Hematologic Effects
    1. Leukopenia
    2. Thrombotic Microangiopathy
  6. Hepatotoxicity
    1. Increased liver transaminases
    2. Risk of liver failure
    3. Avoid with other Hepatotoxins
    4. Monitor Liver Function Tests
  7. Pulmonary Arterial Hypertension
  8. Congestive Heart Failure
  9. Autoimmune disorders
  10. Seizures

VII. Safety

  1. Pregnancy Category C
  2. Unknown Safety in Lactation

VIII. Efficacy

  1. Decreases Multiple Sclerosis exacerbation frequency
  2. Decreased risk of Disability progression
  3. Decreased MS related CNS Lesions

Images: Related links to external sites (from Bing)

Related Studies

Cost: Medications

avonex (on 7/11/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
AVONEX PEN 30 MCG/0.5 ML KIT $7,309.73 each
AVONEX PREFILLED SYR 30 MCG KIT $7,341.09 each

Ontology: Interferon-beta (C0015980)

Definition (NCI) A class of interferon elaborated by fibroblasts.
Definition (MSH) One of the type I interferons produced by fibroblasts in response to stimulation by live or inactivated virus or by double-stranded RNA. It is a cytokine with antiviral, antiproliferative, and immunomodulating activity.
Definition (CSP) major interferon produced by double stranded RNA induced fibroblast cultures; the primary producer cells are fibroblasts, epithelial cells and macrophages, and the major activity is antiviral.
Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116) , Immunologic Factor (T129)
MSH D016899
SnomedCT 420710006, 136112008, 84905003
LNC LP18172-4, MTHU003525
English beta Interferon, beta-Interferon, Interferon, beta, Interferon, Fibroblast, Interferon beta (substance), fibroblast interferon, Interferon-beta [Chemical/Ingredient], beta-interferon, interferon-beta, beta interferons, beta interferon, IFNb, interferon beta natural, interferon beta, Interferon.beta, Interferon beta, Beta interferon, Interferon beta (product), Beta interferon (substance), IFN-B, Fibroblast Interferon, Endogenous Interferon Beta, IFN-Beta, Interferon Beta, Natural, Interferon Beta, Interferon, Beta, Natural human interferon beta, Beta Interferon, Beta-Interferon, Interferon-beta
Spanish interferón beta (sustancia), beta interferón (sustancia), beta interferón, interferón beta (producto), interferón beta, Interferón Fibroblastico, Interferón beta
Swedish beta-interferon
Czech interferon beta, interferon fibroblastový
Finnish Beetainterferoni
French IFN-bêta, Interféron fibroblastique, Interféron bêta
Russian BETA-INTERFERON, INTERFERON BETA, INTERFERON-BETA, INTERFERON FIBROBLASTOV, БЕТА-ИНТЕРФЕРОН, ИНТЕРФЕРОН БЕТА, ИНТЕРФЕРОН-БЕТА, ИНТЕРФЕРОН ФИБРОБЛАСТОВ
Japanese インターフェロン-ベータ, ベータインターフェロン, インターフェロン-線維芽細胞, 線維芽細胞インターフェロン, インターフェロンβ
Italian Interferone fibroblastico, Beta-interferone, Interferone beta
Polish Interferon beta, Interferon fibroblastów
Croatian INTERFERON-BETA, INTERFERON BETA
German Beta-Interferon, Interferon, Fibroblasten-, Interferon-Beta
Portuguese Interferon beta, Interferon de Fibroblastos

Ontology: Interferon beta-1a (C0254119)

Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116) , Immunologic Factor (T129)
MSH C086937
SnomedCT 386902004, 108749003
English interferon beta 1a, interferon beta-1a, INTERFERON BETA-1A, 1a beta interferon, Interferon beta-1a (substance), Interferon beta-1a preparation (product), Interferon beta-1a preparation, Interferon beta-1a preparation (substance), Interferon beta-1a, Interferon Beta-1a
Spanish preparado de interferón beta - 1a, preparado de interferón beta-1a (producto), interferón beta-1a, interferón beta-1a (producto), preparado de interferón beta-1a, interferón beta - 1a (sustancia), interferón beta - 1a, preparado de interferón beta - 1a (sustancia), preparado de interferón beta-1a (sustancia)

Ontology: Avonex (C0594372)

Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116) , Immunologic Factor (T129)
MSH C086937
English Avonex, avonex, Biogen brand of Interferon beta 1a

Ontology: Rebif (C0752980)

Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116)
MSH C086937
English Rebif, rebif, Serono brand of interferon beta 1a

Ontology: peginterferon beta-1a (C3848580)

Concepts Pharmacologic Substance (T121)
English peginterferon beta-1a, PEGINTERFERON BETA-1A

Ontology: Plegridy (C3848664)

Concepts Pharmacologic Substance (T121)
English Plegridy