1
|
Interferon Beta-1b for the Treatment of Multiple Sclerosis – More than 10 Years of Experience. ACTA MEDICA MARISIENSIS 2019. [DOI: 10.2478/amma-2019-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective: Interferon beta-1b (IFNβ-1b) was the first disease-modifying agent (DMT) used for the treatment of multiple sclerosis (MS). We aimed to evaluate the first patients with MS that started treatment in our clinic.
Methods: An observational, retrospective study was performed on 78 patients that had continuous treatment with IFNβ-1b for more than 10 years. The collection of the demographical data and periodical clinical evaluation was performed on all patients. The disability was quantified using the Expanded Disability Status Scale (EDSS), creating two groups of patients, G1: EDSS < 4.0 and G2: EDSS ≥ 4.0. The hallmarks of the disability evolution were gathered by direct patient interview, such as the symptoms at onset and relapse frequency.
Results: After more than 17 years of disease evolution, more than half (65.38%) of the patients present a mild disability score. The majority (54.90%) started treatment in the first three years after the onset, while the patients in G2 started treatment after more than 3 years from the onset. The initiation of IFNβ-1b lead to a significant reduction of the relapse rates. A reduced number of patients (<25%) transitioned from RRMS to SPMS.
Discussion: Continuous evaluation of MS patients allows us to assess the possibility of prolonged treatment with IFNβ-1b and to differentiate the responders from non-responders. The clear reduction in relapse rates and disability progression, notably in patients that started treatment early ensure us into continuing administering this medication. Compared to historical cohorts, our lot had a slower disability evolution and a significant proportion hadn’t reach an important disability score.
Collapse
|
2
|
Recombinant Interferons Beta-1a and Beta-1b: Protein Structural Features and Problematic Issues with Identity Confirmation. Pharm Chem J 2018. [DOI: 10.1007/s11094-018-1892-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
3
|
Cultural adaptation and validation of a peninsular Spanish version of the MSTCQ© (Multiple Sclerosis Treatment Concerns Questionnaire). NEUROLOGÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.nrleng.2014.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
4
|
Muntéis Olivas E, Navarro Mascarell G, Meca Lallana J, Maestre Martínez A, Pérez Sempere Á, Gracia Gil J, Pato Pato A. Adaptación cultural y validación al español de España del MSTCQ© (Multiple Sclerosis Treatment Concerns Questionnaire). Neurologia 2017; 32:29-39. [DOI: 10.1016/j.nrl.2014.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 12/04/2014] [Accepted: 12/09/2014] [Indexed: 11/28/2022] Open
|
5
|
Mathaes R, Koulov A, Joerg S, Mahler HC. Subcutaneous Injection Volume of Biopharmaceuticals—Pushing the Boundaries. J Pharm Sci 2016; 105:2255-9. [DOI: 10.1016/j.xphs.2016.05.029] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 05/13/2016] [Accepted: 05/17/2016] [Indexed: 11/16/2022]
|
6
|
Marziniak M, Meuth S. Current perspectives on interferon Beta-1b for the treatment of multiple sclerosis. Adv Ther 2014; 31:915-31. [PMID: 25182864 PMCID: PMC4177103 DOI: 10.1007/s12325-014-0149-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Indexed: 01/09/2023]
Abstract
Interferon (IFN) beta-1b was the first disease-modifying therapy to be approved for the treatment of multiple sclerosis (MS), and over 21 years of follow-up data demonstrate its efficacy and long-term safety profile. Following recent regulatory approvals in the USA and European Union, IFN beta-1b is now one of the seven disease-modifying therapies [intramuscular IFN beta-1a; subcutaneous (SC) IFN beta-1a; IFN beta-1b SC; glatiramer acetate SC; oral dimethyl fumarate; oral teriflunomide; and intravenous alemtuzumab] indicated for first-line use in relapsing–remitting MS. Here we review the clinical trial and follow-up data for IFN beta-1b and discuss factors that clinicians may consider when selecting this treatment, both at first line in early MS, and later in the disease course.
Collapse
|
7
|
Short-term and long-term safety and tolerability of interferon β-1b in multiple sclerosis. Mult Scler Relat Disord 2013; 3:294-302. [PMID: 25876467 DOI: 10.1016/j.msard.2013.11.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 11/08/2013] [Accepted: 11/20/2013] [Indexed: 11/20/2022]
Abstract
Clinical trials have generated a wealth of data on the safety profile of interferon β-1b for patients with multiple sclerosis (MS). In general, interferon β-1b has not been associated with serious or life-threatening side effects during long-term treatment. Flu-like symptoms, injection site reactions, depression, and elevated liver transaminases were the most common adverse events in clinical trials. This review will discuss the rates of these and other common adverse events observed in 3 clinical trials of interferon β-1b: BENEFIT, BEYOND, and the 16-year Long-Term Follow-up (LTF) of the pivotal interferon β-1b trial in MS, as well as how these adverse events may influence patient and physician decision making when selecting a disease-modifying therapy. In addition, we will discuss the effects of interferon β-1b on mortality in the 16-year and 21-year LTF studies.
Collapse
|
8
|
Boeru G, Milanov I, De Robertis F, Kozubski W, Lang M, Rojas-Farreras S, Tomlinson M. ExtaviJect® 30G device for subcutaneous self-injection of interferon beta-1b for multiple sclerosis: a prospective European study. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2013; 6:175-84. [PMID: 24255602 PMCID: PMC3832381 DOI: 10.2147/mder.s52590] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background The ExtaviJect® 30G autoinjector was developed to facilitate parenteral self-administration of interferon beta-1b (Extavia®), a first-line disease-modifying therapy in patients with multiple sclerosis. Our aim was to assess patient compliance with treatment when using the autoinjector, patients’ and nurses’ experiences of using the device, its tolerability, and patient satisfaction. Methods This was a 12-week, real-world, prospective, observational, noninterventional study conducted in nine European countries. Questionnaires were used to measure patient compliance and to assess patients’ and nurses’ experiences. All adverse events were recorded by severity, including injection site reactions or pain. Patient satisfaction and health-related quality of life were assessed using the Treatment Satisfaction Questionnaire for Medication-9 (TSQM-9) and EuroQol-5 Dimension (EQ-5D) instruments, respectively. Results Of 582 patients enrolled, 568 (98%) received at least one injection and attended the first follow-up visit at 6 weeks, and 542 (93%) attended the second follow-up visit at 12 weeks. For the whole study, 548 of 568 (97%) patients were compliant with treatment. Among the various questions assessing whether the device was easy and quick to use accurately, without fear of the needle, 56%–98% of patients and 59%–98% of nurses were in agreement. There were nine serious adverse events (four disease-related) reported among the 227 (39%) patients reporting adverse events. Scores increased in the TSQM-9 convenience domain between weeks 6 and 12 (P=0.0009), and in the EQ-5D visual analog scale between baseline and week 12 (P<0.0001), indicating improvement in health-related quality of life. Conclusion ExtaviJect 30G was convenient to use and was associated with high levels of compliance.
Collapse
|
9
|
Singer B, Bandari D, Cascione M, LaGanke C, Huddlestone J, Bennett R, Dangond F. Comparative injection-site pain and tolerability of subcutaneous serum-free formulation of interferonβ-1a versus subcutaneous interferonβ-1b: results of the randomized, multicenter, Phase IIIb REFORMS study. BMC Neurol 2012; 12:154. [PMID: 23216674 PMCID: PMC3541262 DOI: 10.1186/1471-2377-12-154] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 11/21/2012] [Indexed: 11/19/2022] Open
Abstract
Background In patients with relapsing–remitting multiple sclerosis (RRMS), subcutaneous (sc) interferon (IFN)β-1a and IFNβ-1b have been shown to reduce relapse rates. A formulation of IFNβ-1a has been produced without fetal bovine serum and without human serum albumin as an excipient (not currently approved for use in the US). The objectives of this study were to evaluate tolerability, injection-site redness, subject-reported satisfaction with therapy, and clinical safety and efficacy of the serum-free formulation of IFNβ-1a versus IFNβ-1b in IFNβ-treatment-naïve patients with RRMS. The objectives of the extension phase were to evaluate long-term safety and tolerability of IFNβ-1a. Methods This randomized, parallel-group, open-label study was conducted at 27 clinical sites in the US. Eligible patients aged 18–60 years were randomized to receive either IFNβ-1a, titrated to 44 μg sc three times weekly (tiw) (n = 65), or IFNβ-1b, titrated to 250 μg sc every other day (n = 64) over 12 weeks. Following this, all patients received IFNβ-1a 44 μg tiw for 82–112 weeks. Primary endpoint was mean change in patient-reported pain, as assessed by visual analog scale (VAS) diary pain score (from 0 mm [no pain] to 100 mm [worst possible pain]) at the injection site, from pre-injection to 30 min post-injection over the first 21 full-dose injections. Secondary assessments included proportion of patients pain-free as recorded by VAS diary and the Short-Form McGill Pain questionnaire VAS. Results A total of 129 patients were included in the intent-to-treat analysis. Mean (standard deviation) change in VAS diary pain score was not significantly different between groups, although numerically lower with IFNβ-1a versus IFNβ-1b from pre-injection to immediately post-injection (1.46 [2.93] vs. 4.63 [10.57] mm), 10 min post-injection (0.70 [1.89] vs. 1.89 [5.75] mm), and 30 min post-injection (0.67 [2.32] vs. 1.14 [4.94] mm). Proportion of patients pain-free at all time periods post-injection was also not significantly different between groups. Adverse events were consistent with the known safety profiles of these treatments. Conclusions In IFNβ-treatment-naïve patients with RRMS, both the serum-free formulation of IFNβ-1a and IFNβ-1b treatments were generally accompanied by low-level injection-site pain and were well tolerated. Trial registration ClinicalTrials.gov NCT00428584
Collapse
Affiliation(s)
- Barry Singer
- Missouri Baptist Medical Center, St, Louis, MO, USA.
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Giovannoni G, Southam E, Waubant E. Systematic review of disease-modifying therapies to assess unmet needs in multiple sclerosis: tolerability and adherence. Mult Scler 2012; 18:932-46. [PMID: 22249762 DOI: 10.1177/1352458511433302] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Reviews of therapeutic drugs usually focus on the highly selected and closely monitored patient populations from randomized controlled trials. The objective of this study was to review systematically the tolerability and adherence of multiple sclerosis disease-modifying therapies, using data from both randomized controlled trials and observational settings. Relevant literature was identified using predefined search terms, and adverse event and study discontinuation data were extracted and categorized according to study type (randomized controlled trial or observational) and study duration. A total of 151 papers were selected for analysis; 33% were classified as randomized controlled trials and 62% as observational studies. Most of the papers concerned interferon preparations and glatiramer acetate; the limited available information on mitoxantrone and natalizumab precluded extensive examination of these. The most common adverse events were flu-like symptoms (interferon therapies only) and injection-site reactions. Mean discontinuation rates ranged from 16% to 27%. There were no marked differences in tolerability or adherence data from randomized controlled trials and observational studies, but the incidence of adverse events remained high in lengthy studies and discontinuations accumulated with time. The present systematic review of randomized clinical trial and observational data highlights the tolerability and adherence issues associated with commonly used first-line multiple sclerosis treatments.
Collapse
Affiliation(s)
- G Giovannoni
- Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | | | | |
Collapse
|
11
|
Factors that influence adherence and strategies to maintain adherence to injected therapies for patients with multiple sclerosis. J Neurosci Nurs 2010; 42:S10-8. [PMID: 21049829 DOI: 10.1097/jnn.0b013e3181ee122b] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A key aspect of the management of care for patients with multiple sclerosis (MS) is identifying which patients are struggling with adherence. Disease-modifying therapies for the treatment of MS are primarily preventative, with modest efficacy, and they can possibly cause significant side effects. These factors can lead patients to stop taking their medication because they continue to experience symptoms or relapses of the disease, and/or they have painful injection-site reactions on most parts of their bodies. However, striving for 100% adherence to the prescribed treatment regimen remains the goal and is the surest way to reap all the benefits associated with immunomodulatory therapy. Building trust, promoting injection self-efficacy, and educating patients about proper injection techniques to prevent injection-site reactions have the greatest impact on patient adherence. Factors including family involvement, financial stability and support, hope, and faith can also have a positive impact on adherence. Identifying patients who may be struggling with depression, which is easily treatable but often not well addressed, and providing access to mental health services are important. Although many strides have been made with regard to MS patient care, outlining strategies that can maintain or encourage adherence can provide practitioners with tools to facilitate their patients' health and well-being.
Collapse
|
12
|
de Sá J, Urbano G, Reis L. Assessment of new application system in Portuguese patients with relapsing-remitting multiple sclerosis. Curr Med Res Opin 2010; 26:2237-42. [PMID: 20687777 DOI: 10.1185/03007995.2010.508688] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the satisfaction level of multiple sclerosis (MS) patients treated with interferon beta-1b (IFNbeta-1b, Betaferon*) using a newly developed application system compared to their currently used application system. METHODS A survey was conducted in Portugal in patients treated with IFNbeta-1b for relapsing-remitting MS with the Betaject or Betaject Lite autoinjector. Nurses demonstrated the new application system and supervised the first injection. Patients rated their overall satisfaction retrospectively with their current application system and prospectively after the first, the seventh and the 15th injection with the newly developed application system. Additionally, the ease of use was evaluated for both application systems using a questionnaire consisting of 13 questions. Responses were compiled and descriptive analyses performed. RESULTS A total of 249 patients evaluated the current and the new system after the first, 235 after the seventh and 174 after the 15th injection. The satisfaction level was high with the current system (70.3%, 'satisfied' or 'very satisfied'). However, compared with the current system, more patients were either 'satisfied' or 'very satisfied' (98%) with the new system after first injection. Only a minority of patients rated 'somewhat satisfied': 2.0% after the first, 8.6% after the seventh, and 4.4% after the 15th injection. Increased overall satisfaction level ('satisfied' or 'very satisfied') with the newly developed system was maintained over time (98% - first, 90.5% - seventh, 93.8% - 15th injection). The thinner, pre-attached 30-gauge needle and the visual signalling of injection completion were among the changes considered as strong improvements to the new system by up to 80.3% of patients. LIMITATION Retrospective analysis of current system. CONCLUSIONS This survey documented patient satisfaction with different application systems of IFNbeta-1b. The increased satisfaction with the new application system indicates an improvement to the currently used injection system, which may contribute to further advancement in adherence and consequently higher clinical efficacy of treatment.
Collapse
Affiliation(s)
- J de Sá
- Hospital de Santa Maria, Serviço de Neurologia, Lisbon, Portugal.
| | | | | |
Collapse
|
13
|
Cohen JA, Barkhof F, Comi G, Hartung HP, Khatri BO, Montalban X, Pelletier J, Capra R, Gallo P, Izquierdo G, Tiel-Wilck K, de Vera A, Jin J, Stites T, Wu S, Aradhye S, Kappos L. Oral fingolimod or intramuscular interferon for relapsing multiple sclerosis. N Engl J Med 2010; 362:402-15. [PMID: 20089954 DOI: 10.1056/nejmoa0907839] [Citation(s) in RCA: 1584] [Impact Index Per Article: 113.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Fingolimod (FTY720), a sphingosine-1-phosphate-receptor modulator that prevents lymphocyte egress from lymph nodes, showed clinical efficacy and improvement on imaging in a phase 2 study involving patients with multiple sclerosis. METHODS In this 12-month, double-blind, double-dummy study, we randomly assigned 1292 patients with relapsing-remitting multiple sclerosis who had a recent history of at least one relapse to receive either oral fingolimod at a daily dose of either 1.25 or 0.5 mg or intramuscular interferon beta-1a (an established therapy for multiple sclerosis) at a weekly dose of 30 microg. The primary end point was the annualized relapse rate. Key secondary end points were the number of new or enlarged lesions on T(2)-weighted magnetic resonance imaging (MRI) scans at 12 months and progression of disability that was sustained for at least 3 months. RESULTS A total of 1153 patients (89%) completed the study. The annualized relapse rate was significantly lower in both groups receiving fingolimod--0.20 (95% confidence interval [CI], 0.16 to 0.26) in the 1.25-mg group and 0.16 (95% CI, 0.12 to 0.21) in the 0.5-mg group--than in the interferon group (0.33; 95% CI, 0.26 to 0.42; P<0.001 for both comparisons). MRI findings supported the primary results. No significant differences were seen among the study groups with respect to progression of disability. Two fatal infections occurred in the group that received the 1.25-mg dose of fingolimod: disseminated primary varicella zoster and herpes simplex encephalitis. Other adverse events among patients receiving fingolimod were nonfatal herpesvirus infections, bradycardia and atrioventricular block, hypertension, macular edema, skin cancer, and elevated liver-enzyme levels. CONCLUSIONS This trial showed the superior efficacy of oral fingolimod with respect to relapse rates and MRI outcomes in patients with multiple sclerosis, as compared with intramuscular interferon beta-1a. Longer studies are needed to assess the safety and efficacy of treatment beyond 1 year. (ClinicalTrials.gov number, NCT00340834.)
Collapse
|
14
|
Abstract
Multiple sclerosis (MS) is an inflammatory demyelinating disease affecting young adults (with a peak of onset between the ages of 20 and 40 years). In 80-90% of cases, it is characterized by an early relapsing-remitting (RR) inflammatory phase, followed by a secondary progressive course in which disability progressively accumulates. Interferon-beta (IFNbeta) therapies represent the first-line treatment of RRMS. There are three IFNbeta formulations currently licensed for RRMS. Two are formulations of INFbeta-1a, one administered at a dosage of 30 mug intramuscularly weekly (Avonex(R)) and the other administered at a dosage of 22 or 44 microg subcutaneously (SC) three times a week (Rebif(R) 22 and 44). The third is a formulation of IFNbeta-1b, administered at a dosage of 250 microg SC every other day (Betaseron(R)). These treatments reduce the frequency of acute relapses and, to a lesser extent, disability progression. However, when starting an IFNbeta therapy, a treatment discontinuation rate ranging from 14% to 44% has to be expected. In a sizable proportion of patients, treatment suspension is caused by the occurrence of adverse effects (most commonly a flu-like syndrome and injection site reactions) and/or poor compliance. Individualized patient education and support are critical to improve adherence to therapy in the long term. Approaches aimed at reducing the proportion of subjects interrupting IFNbeta encompass both pharmacological and non-pharmacological interventions, and may involve several professional figures, such as the neurologist, the psychologist, the pharmacist, the physical and speech therapist, and the nurse. Recently, the development of new IFNbeta formulations, with reduced immunogenic potential, has offered an additional approach to improving patient adherence. Biferonex(R) is a pH neutral and human serum albumin-free IFNbeta-1a. A phase III, 2-year study of the product involving patients with RRMS has been conducted, but the results were not considered conclusive enough to allow approval in Europe. Rebif(R) New Formulation (RNF) is a formulation of INFbeta-1a that is not produced using fetal bovine serum and that does not have human serum albumin as an excipient. The formulation has been approved in Europe and an application for approval has been filed in the US. On the basis of the final analysis of a phase III trial, RNF showed higher tolerability, particularly in terms of injection site reactions, compared with the older formulation. Further studies assessing its usefulness as an alternative therapy for patients who are intolerant of other IFNbeta formulations are required.
Collapse
Affiliation(s)
- Emilio Portaccio
- Department of Neurology, University of Florence, Florence, Italy.
| | | |
Collapse
|
15
|
Perrin Ross A. The Importance of Early Treatment. J Neurosci Nurs 2009. [DOI: 10.1097/jnn.0b013e3181a23ea9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
16
|
|