Questions often come up about how to improve tolerability and safe use of meds for relapsing multiple sclerosis.
Interferon beta (Avonex, etc) and glatiramer acetate (Copaxone) are self-injectables with a long track record and modest efficacy.
Oral Tecfidera, Gilenya, and Aubagio seem to work at least as well as injections…but have more safety concerns.
Expect monoclonal antibodies (Tysabri, Zinbryta, etc) to generally be saved for patients with relapsing MS who don’t respond to other meds.
Be aware that these therapies are usually specialty meds…due to their high cost and patient education and monitoring requirements.
Side effects. Suggest strategies to improve tolerability and adherence. For example, teach patients with multiple sclerosis to rotate injection sites and let refrigerated meds warm to room temp to limit injection-site reactions.
Reassure that flu-like symptoms with interferon beta usually wane within 3 months. Suggest an NSAID or acetaminophen if needed.
Glatiramer acetate may cause transient flushing, chest pain, or shortness of breath. But explain treatment usually isn’t needed.
Advise patients on Tecfidera® that flushing usually lessens over time. Suggest taking it with food or taking up to 325 mg of non-enteric-coated aspirin 30 minutes before the dose to help minimize this effect.
Safe use. Evaluate interactions closely. For instance, taking Gilenya with digoxin, diltiazem, or a beta-blocker may cause severe bradycardia or heart block.
Emphasize use of effective contraception, especially with Aubagio.
Feel comfortable giving inactivated vaccines (injectable flu, etc) to stable patients with multiple sclerosis…but try to give live vaccines (Zostavax II, etc) at least one month before patients start most MS meds.