II. Indications
-
Multiple Sclerosis - Relapsing Remitting
- Interferon has the longest use in MS than any of the other immunomodulators
III. Mechanism
-
Interferon is an endogenous Cytokine (integral to inflammatory and immune responses)
- Released from Lymphocytes, Dendritic Cells, Macrophages, fibroblasts, Natural Killer Cells and T Cells
-
Interferon is subdivided into three main types (alpha, beta, gamma)
- Alpha and beta Interferon both have Antiviral activity
- Synthesized alpha Interferon has primarily been used for Viral Hepatitis B and C infection, as well as cancer
- Synthesized beta Interferon has primarily been used to treat Multiple Sclerosis
-
Interferon Beta is a type 1 Interferon, a Cytokine produced by fibroblasts
- Released in response to viral contact or DS-DNA
- Has Antiviral, antiproliferative and immunomodulator activity
IV. Medications
- Interferon Beta-1B (Betaseron, Extavia): 0.3 mg single-dose vial (needs reconstitution)
V. Dosing
- Week 1-2: Give 0.0625 mg (0.25 ml) SQ every other day
- Week 3-4: Give 0.125 mg (0.5 ml) SQ every other day
- Week 5-6: Give 0.1875 mg (0.75 ml) SQ every other day
- Maintenance: 0.25 mg (1 ml) SC every other day
- Consider pretreat with Analgesics and Antihistamines to reduce flu-like reactions
VI. Adverse Effects
- Allergic Reactions (including Anaphylaxis)
- Local injection site inflammation
- Influenza-like symptoms (decreases after first 3 months)
- Mental health adverse effects
- Exacerbation of depressed mood (including increased Suicidality)
- Psychosis
- Hematologic Effects
- Hepatotoxicity
- Increased liver transaminases
- Risk of liver failure
- Avoid with other Hepatotoxins
- Monitor Liver Function Tests
- Pulmonary Arterial Hypertension
- Congestive Heart Failure
- Autoimmune disorders (including Drug-induced Lupus)
- Seizures
VII. Safety
- Unknown safety in Lactation
- Unknown safety in pregnancy
- No observed adverse effects in pregnancy in studies
- Monitoring (obtain at 1, 3 and 6 months)
VIII. Efficacy
- Decreases Multiple Sclerosis exacerbation frequency
- Decreased risk of Disability progression
- Decreased MS related CNS Lesions
IX. Resources
X. References
- Filippini (2003) Lancet 361:545-52
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