9.21.11 - medications used in the treatment of multiple sclerosis

Following the idea of my previous posts, I am going to share information from different websites that discuss aspects of MS and include my personal experiences.

Comparing Drugs for Multiple Sclerosis

Laura Dean, MD.

Created: February 11, 2011.

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system. MS affects the myelin coating of nerves, interrupting nerve conduction and leaving lesions that can be seen on brain scans.

Symptoms of MS can be unpredictable, and include changes in sensation, muscle weakness, and problems with balance and coordination. Symptoms may gradually develop and worsen over time, or more commonly, occur in acute attacks (relapses) followed by symptom-free periods (remissions). About 85% of patients have the relapsing-remitting form of MS (RRMS), and most cases eventually develop into a secondary progressive form (SPMS).

The management of MS includes treating symptoms (e.g. muscle relaxants for muscle spasms) and acute flare-ups (e.g. high dose steroids for sudden loss of vision). Disease-modifying drugs are used to slow the progression of MS. These drugs modify the immune response and include the β interferons (Avonex, Rebif, Betaseron, and Extavia), glatiramer acetate (Copaxone), mitoxantrone (Novantrone) and natalizumab (Tysabri).

The "Drug Class Review on Disease-modifying drugs for Multiple Sclerosis" compares the safety and effectiveness of seven drugs. A summary of the findings is below.

How do disease-modifying drugs compare in multiple sclerosis?

In patients with relapsing-remitting multiple sclerosis, Avonex is less effective than Rebif and Betaseron for preventing relapse. Fair evidence suggests that Rebif is similar to Avonex for slowing disease progression. Evidence comparing Betaseron to Avonex for preventing disease progression was conflicting, with one trial showing Betaseron more effective for slowing disease progression, but no difference between the drugs in measures of disability.
No differences were found between Copaxone and Rebif or Betaseron in either relapse rates or disease progression.
Direct comparisons are lacking in other types of multiple sclerosis. Natalizumab and mitoxantrone have not been directly compared to other disease-modifying drugs. [details]

How do disease-modifying drugs compare in clinically isolated syndrome?

Compared to placebo, the following drugs were more effective at reducing the chances of a clinically isolated syndrome converting into multiple sclerosis: Avonex, Betaseron, Copaxone, and Rebif.
There are no studies of Novantrone or Tysabri in patients with a clinically isolated syndrome. [details]

How do disease-modifying drugs compare in safety?

Interferons appear to share a similar rate of adverse events. Increases in liver enzymes are common, but most are transient and asymptomatic. Avonex had the lowest rate of injection site reactions (9%, compared to ~ 60% for Betaseron and Rebif) but flu-like symptoms were about twice as common.
Data are limited for other adverse events, such as for depression, but suggest a lower rate of depression in patients taking Rebif compared with other interferons. Mitoxantrone has been linked with acute leukemia (2 in 1620 patients) and cardiotoxicity (incidence 0.15%), and natalizumb has been linked with progressive multifocal leukoencephalopathy (incidence 0.001%). [details]

How do patient factors affect the safety and effectiveness of disease-modifying drugs?

Observational studies of women taking beta interferons or glatiramer in pregnancy did not find an increase in risk of adverse events, but there is not enough evidence to determine the safety of multiple sclerosis drugs in pregnancy.
One analysis found that African-American patients were more likely to experience exacerbations with Avonex and Rebif compared to white patients.
There is some evidence that response to beta interferons and glatiramer differs in men and women, but there is no evidence that this difference favors one product over another. [details]

Drugs included in this review

Generic Name        Trade Names

Glatiramer Acetate                   Copaxone

Glatiramer Injection(gla tir' a mer)

Last reviewed: February 1, 2009.

Why is this medication prescribed?

Glatiramer is used to reduce episodes of symptoms in patients with relapsing-remitting multiple sclerosis. Glatiramer is in a class of medications called immunomodulators. It works by stopping the body from damaging its own nerve cells (myelin).

How should this medicine be used?

Glatiramer comes as a solution to inject in the fatty layer just under the skin (subcutaneously). It is usually injected once a day. To help you remember to inject glatiramer, inject it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use glatiramer exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.
You will receive your first dose of glatiramer in your doctor's office. After that, you can inject glatiramer yourself or have a friend or relative perform the injections. Before you use glatiramer yourself the first time, read the written instructions that come with it. Ask your doctor or pharmacist to show you or the person who will be injecting the medication how to inject it.
Glatiramer comes in prefilled syringes. Use each syringe only once and inject all the solution in the syringe. Even if there is still some solution left in the syringe after you inject, do not inject again. Dispose of used syringes in a puncture-resistant container. Talk to your doctor or pharmacist about how to dispose of the puncture-resistant container.
You can inject glatiramer into seven parts of your body: right and left arms, thighs, and hips; and lower stomach. There are specific spots on each of these body parts where you can inject glatiramer. Refer to the diagram in the manufacturer's patient information for the exact places you can inject. You should inject in each of the body parts once a week, and you should pick a different place on the body part each time. Keep a list of the places where you have given injections so that you will not inject in these places again until some time has passed.
To inject glatiramer, follow these steps:

1. Remove one blister pack from the carton of glatiramer syringes and place it on a clean flat surface. Wait 20 minutes to allow the medication to warm to room temperature.
2. Wash your hands thoroughly with soap and water and dry them with a clean towel.
3. Peel back the paper label and remove the syringe from the blister pack. Check your pre-filled syringe to be sure it is safe to use. It should be labeled with the correct name of the medication and should contain a clear colorless solution. Do not use the syringe if it is expired, is cloudy, or contains any particles. Small air bubbles in the syringe will not cause any problems and you should not try to remove them.
4. Wipe the place on your skin where you will inject glatiramer with a fresh alcohol pad and wait several seconds to allow it to dry.
5. Pick up the syringe like a pencil and remove the needle cover.
6. Use your other hand to pinch a 2-inch (5-centimeter) fold of skin between your thumb and index finger.
7. Hold the syringe at a 90-degree angle to your body and push the needle straight into your skin. When the needle is all the way in, let go of the pinched fold of skin.
8. Hold the syringe steady while slowly pushing down the plunger until the syringe is empty.
9. Pull the needle straight out.
10. Press a dry cotton ball on the injection site for a few minutes, but do not rub it.

Glatiramer controls multiple sclerosis but does not cure it. Continue to use glatiramer even if you feel well. Do not stop using glatiramer without talking to your doctor.

Other uses for this medicine

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before taking glatiramer,

• tell your doctor and pharmacist if you are allergic to glatiramer, mannitol, or any other medications.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have or have ever had kidney disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using glatiramer, call your doctor.
• you should know that you may have a reaction immediately after you inject glatiramer. You may experience the following symptoms: flushing, chest pain, pounding heartbeat, anxiety, trouble breathing, closing of the throat, and hives. This reaction is most likely to occur several months into your treatment, but may happen at any time. These symptoms will usually go away without treatment in a short time. Get emergency medical care if these symptoms become severe or last longer than a few minutes. It is important to tell your doctor if this happens.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?

Inject the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not inject a double dose to make up for a missed one.

What side effects can this medication cause?

Glatiramer may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• pain, redness, swelling, itching, or lump in the place where you injected glatiramer
• weakness
• flushing
• depression
• abnormal dreams
• pain in the back, neck, or any other part of the body
• severe headache
• loss of appetite
• diarrhea
• nausea
• vomiting
• weight gain
• swelling of the hands, feet, ankles, or lower legs
• purple patches on skin
• joint pain
• confusion
• nervousness
• crossed eyes
• difficulty speaking
• shaking hands that you cannot control
• sweating
• ear pain
• painful or changed menstrual periods
• vaginal itching and discharge
• urgent need to urinate or defecate
• tightness in muscles
• white patches in the mouth

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately. In some cases, your doctor may tell you to stop using glatiramer:

• dizziness
• excessive sweating
• chest pain
• sore throat, fever, chills, and other signs of infection
• runny nose
• coughing
• fast heartbeat
• fainting
• skin rash
• hives
• itching
• difficulty breathing or swallowing
• very severe pain at the injection site

Glatiramer affects your immune system, so it may increase your risk of developing cancer or a serious infection. Talk to your doctor about the risks of using this medication.
Glatiramer may cause other side effects. Call your doctor if you have any unusual problems while using this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch] or by phone [1-800-332-1088].

What storage conditions are needed for this medicine?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it in a refrigerator but do not freeze it. If you will not have access to a refrigerator, you can store glatiramer at room temperature for up to 7 days, but do not expose it to bright light. Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

What other information should I know?

Keep all appointments with your doctor.
Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

Other names

• copolymer-1

American Society of Health-System Pharmacists, Disclaimer

AHFS^® Consumer Medication Information. © Copyright, 2011. The American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.

                                                                                    

Interferon β 1a                          Avonex

                                                       Avonex PS

    Interferon beta-1a Subcutaneous Injection(in ter feer' on) 

 

 

Last reviewed: September 1, 2008.

Why is this medication prescribed?

Interferon beta-1a is used to prevent episodes of symptoms and slow the development of disability in patients with relapsing-remitting multiple sclerosis (MS, a disease in which the nerves do not function properly and patients may experience weakness, numbness, loss of muscle coordination and problems with vision, speech, and bladder control). Interferon beta-1a has not been shown to help patients with chronic progressive MS. Interferon beta-1a is in a class of medications called immunomodulators. It is not known how interferon beta-1a works to treat MS.

How should this medicine be used?

Interferon beta-1a subcutaneous injection comes as a solution to inject subcutaneously (under the skin) three times a week. You should inject this medication on the same 3 days every week, for example, every Monday, Wednesday, and Friday. The injections should be spaced at least 48 hours apart, so it is best to inject your medication around the same time of day on each of your injection days. The best time to inject this medication is in the late afternoon or evening. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use interferon beta-1a exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

Your doctor may start you on a low dose of interferon beta-1a and gradually increase your dose, not more than once every 2 weeks.

Interferon beta-1a controls symptoms of MS, but does not cure it. Continue to use interferon beta-1a even if you feel well. Do not stop using interferon beta-1a without talking to your doctor.

You will receive your first dose of interferon beta-1a in your doctor's office. After that, you can inject interferon beta-1a yourself or have a friend or relative perform the injections. Before you use interferon beta-1a yourself the first time, read the written instructions that come with it. Ask your doctor or pharmacist to show you or the person who will be injecting the medication how to inject it.

Interferon beta-1a comes in prefilled syringes. Use each syringe and needle only once and inject all the solution in the syringe. Even if there is still some solution left in the syringe after you inject, do not inject again. Throw away used syringes and needles in a puncture-resistant container kept out of reach of children. Talk to your doctor or pharmacist about how to throw away the puncture-resistant container.

You can inject interferon beta-1a in areas of your body with a layer of fat between the skin and muscle, such as your thigh, the outer surface of your upper arms, your stomach, or your buttocks. If you are very thin, only inject in your thigh or the outer surface of your arm for injection. Use a different spot for each injection. Keep a record of the date and spot of each injection. Do not use the same spot two times in a row. Do not inject near your navel (belly button) or waistline or into an area where the skin is sore, red, bruised, scarred, infected, or abnormal in any way.

To inject interferon beta-1a, follow these steps:

1. Remove the prefilled syringe from the refrigerator and allow it to warm to room temperature for about 30 minutes before using. Do not use a heat source such as hot water or a microwave to warm the syringe.
2. Check the syringe to be sure it is safe to use. The syringe should be labeled with the correct name of the medication and an expiration date that has not passed and should contain a clear to slightly yellow solution. If the syringe is expired, or the solution is cloudy, discolored, or contains particles, do not use it and call your pharmacist.
3. Set up a clean, well-lit, flat work surface, like a table, to collect all the supplies you will need to inject interferon beta-1a. Assemble these supplies: alcohol wipes, gauze pad, small adhesive bandage, and puncture-resistant container for disposal of used syringes and needles.
4. Wash your hands well with antibacterial soap.
5. Choose a spot to inject interferon beta-1a and clean it with an alcohol wipe, using a circular motion. Let the skin air dry.
6. Remove the cap from the syringe needle.
7. The syringe should be filled with interferon beta-1a to the 0.5-mL mark. This is a full dose. If your doctor has told you to use less than the full dose, slowly push the syringe plunger in until the amount of medication left in the syringe is the amount your doctor told you to use.
8. Use your thumb and forefinger to pinch up a pad of skin around the spot where you will inject interferon beta-1a. Hold the syringe like a pencil with your other hand.
9. Hold the syringe at a 90-degree angle (straight up and down), and push the needle straight into your skin, stopping just underneath the skin.
10. When the needle is in, let go of the pinched skin and slowly push down on the syringe plunger until the syringe is empty.
11. Hold a gauze pad near the needle and pull the needle straight out of the skin. Use the gauze pad to apply pressure to the spot for a few seconds. You may cover the spot with a bandage.
12. Throw away the used syringe, needle, and gauze pad properly.
13. Apply a cold compress or ice pack to the injection spot to help reduce redness, swelling, or tenderness that may occur.
14. After 2 hours, check the injection spot for redness, swelling, or tenderness. If you have redness, swelling, or tenderness that does not go away in a few days or is severe, call your doctor.

Other uses for this medicine

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before using interferon beta-1a,

• tell your doctor and pharmacist if you are allergic to interferon beta-1a, any other interferon product, any other medications, or human albumin.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: acetaminophen (Tylenol, others); antidepressants; azathioprine (Imuran); cancer chemotherapy medications; carbamazepine (Tegretol); chloramphenicol (Chloromycetin); cholesterol-lowering medications (statins); cyclosporine (Neoral, Sandimmune); gold compounds such as auranofin (Ridaura) and aurothioglucose (Solganol); heparin; iron products; isoniazid (INH, Nydrazid); medications for acquired immunodeficiency syndrome (AIDS) or human immunodeficiency virus (HIV); methotrexate (Rheumatrex); niacin (nicotinic acid); penicillamine (Cuprimine, Depen); phenytoin (Dilantin, Phenytek); rifampin (Rifadin, Rimactane); sirolimus (Rapamune); sulfa antibiotics such as sulfamethoxazole (Bactrim, Septra) and sulfisoxazole (Gantrisin); thyroid medications; and tacrolimus (Prograf). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you drink or have ever drunk large amounts of alcohol and if you have or have ever had AIDS or HIV; an autoimmune disease (a disease in which the body attacks its own cells; ask your doctor if you are not sure if you have this type of disease); blood problems such as anemia (low red blood cells) or easy bruising or bleeding; anxiety, depression, or mental illness; cancer; seizures; or kidney, liver, or thyroid disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using interferon beta-1a, call your doctor immediately.
• if you are having surgery, including dental surgery, tell the doctor or dentist you are using interferon beta-1a.
• ask your doctor about the safe use of alcoholic beverages while you are using interferon beta-1a. Alcohol can make the side effects of interferon beta-1a worse.
• you should know that you may have flu-like symptoms such as headache, fever, chills, sweating, muscle aches, back pain, and tiredness that last for a day after your injection. Your doctor may tell you to take an over-the-counter pain and fever medication to help with these symptoms. These symptoms usually improve or go away over time. Talk to your doctor if these symptoms last longer than the first few months of therapy, or if they are difficult to manage or become severe.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?

Inject the missed dose as soon as you remember it. If you are scheduled for a dose the following day, skip that dose. Do not inject interferon beta-1a 2 days in a row. Do not inject a double dose to make up for a missed dose. You should return to your regular dosing schedule the following week. Call your doctor if you miss a dose and have questions about what to do.

What side effects can this medication cause?

Interferon beta-1a may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• dry eyes
• dry mouth
• nausea
• vomiting
• stomach pain
• tight muscles
• bruising, pain, redness, swelling, or tenderness in the place where you injected interferon beta-1a

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

• depression
• thoughts of hurting yourself or others
• anxiety
• hives
• skin rash
• itching
• flushing
• difficulty breathing or swallowing
• lightheadedness
• fainting
• seizures
• loss of coordination
• vision problems
• extreme tiredness
• lack of energy
• loss of appetite
• pain in the upper right part of the stomach
• yellowing of the skin or eyes
• pale skin
• chest pain
• fast heartbeat
• difficulty sleeping
• unusual bruising or bleeding
• swollen glands in your neck
• sore throat, cough, fever, chills, or other signs of infection
• unexplained weight gain or loss
• feeling cold or hot all the time
• blackening of skin or drainage in the place where you injected interferon beta-1a

Interferon beta-1a may cause other side effects. Call your doctor if you have any unusual problems while using this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch] or by phone [1-800-332-1088].

What storage conditions are needed for this medicine?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it in the refrigerator, but do not freeze it. If a refrigerator is not available, you can store the medication at room temperature away from heat and light for up to 30 days. Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

American Society of Health-System Pharmacists, Disclaimer

AHFS^® Consumer Medication Information. © Copyright, 2011. The American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.

Interferon β 1a                          Rebif

                                                                                    

 

Interferon β 1b                          Betaseron

Interferon Beta-1b Injection(in ter feer' on)

Last reviewed: September 1, 2008.

About your treatment

Your doctor has ordered interferon beta-1b, a biologic response modifier. This medication is used to treat patients with multiple sclerosis (MS), a disease in which the nerves do not function properly and patients may experience weakness; numbness; loss of muscle coordination; and problems with vision, speech, and bladder control. This medication will be injected subcutaneously (under the skin) every other day. Your healthcare provider will show you how to prepare and give the injection.
Interferon beta-1b is a man-made version of a naturally occurring protein. It is used to treat patients with relapsing forms of MS (course of disease where symptoms flare up for a short time, then go away). Interferon beta-1b does not cure MS but may reduce the number of disease flare-ups. Interferon beta-1b may be prescribed for other uses; ask your doctor or pharmacist for more information.
Your healthcare provider (doctor, nurse, or pharmacist) may measure the effectiveness and side effects of your treatment using laboratory tests and physical examinations. It is important to keep all appointments with your doctor and the laboratory. The length of treatment depends on how you respond to the medication.

What special precautions should I follow?

Before using interferon beta-1b,

• tell your doctor and pharmacist if you are allergic to interferon beta-1b, or any other medications, or human albumin.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you drink or have ever drunk large amounts of alcohol, if you have or have ever had anemia (low red blood cells) or low white blood cells, blood problems such as bruising easily or bleeding, diabetes, anxiety, depression, mental illness, thoughts of hurting yourself, seizures, trouble falling asleep or staying asleep, or prostate, skin, thyroid, blood, heart, or liver disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using interferon beta-1b, stop using interferon beta-1b immediately and call your doctor.

Administering your medication

Before you administer interferon beta-1b, look at the solution closely. It should be clear and free of floating material. Observe the solution container to make sure there are no leaks and check the expiration date. Do not use the solution if it is discolored, if it contains particles, or if the container leaks or it is expired. Use a new solution, but show the damaged or expired one to your healthcare provider.
It is important that you use your medication exactly as directed. Your healthcare provider may start you on a low dose of interferon beta-1b and gradually increase your dose. Do not change your dosing schedule without talking to your healthcare provider. Your injections should be approximately 48 hours (2 days) apart, so it is best to give them at the same time, preferably in the evening just before bedtime.
Do not inject interferon beta-1b into an area of skin that is irritated, sore, red, bruised, infected, damaged, or abnormal in any way. It is important that you change your injection area each time interferon beta-1b is injected; keeping a record will help you to remember to rotate injection sites. Do not use the same injection area two times in a row. Do not inject interferon beta-1b near the navel (bellybutton) or waistline.
If you miss a dose of interferon beta-1b, inject your next dose as soon as you remember or are able to give it. Your next injection should then be given 48 hours (2 days) after that dose. Do not use interferon beta-1b on 2 days in a row. If you accidentally use more than your prescribed dose, or give it on 2 days in a row, call your healthcare provider right away.

What side effects can this medication cause?

Side effects from interferon beta-1b can occur. Interferon beta-1b sometimes causes a flu-like illness with headache, fever, chills, sweating, muscle aches, tiredness, and general discomfort. Tell your healthcare provider if any of these problems continue or worsen. You should talk with your healthcare provider about whether to take an over-the-counter medication for pain or fever before or after using your dose of interferon beta-1b.
Tell your healthcare provider if any of these symptoms are severe or do not go away:

• nausea
• indigestion
• diarrhea
• constipation
• weight gain or weight loss
• feeling cold or hot much of the time
• dizziness
• increased urinary frequency
• incontinence
• flushing
• hair loss
• joint or muscle weakness or pain
• leg cramps
• difficulty falling asleep or staying asleep
• changes in sex drive or ability (in men)
• increased menstrual pain

If you experience any of the following symptoms, call your healthcare provider immediately:

• extreme tiredness
• lack of energy
• unusual bruising or bleeding
• loss of appetite
• pain in the upper right part of the stomach
• yellowing of the skin or eyes
• hives
• rash
• itching
• difficulty breathing or swallowing
• swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, abdomen (stomach), or lower legs
• hoarseness
• vaginal bleeding or spotting between menstrual periods
• change in coordination
• heart palpitations or rapid heart rate
• chest pain
• nervousness
• depression
• anxiety
• thoughts of hurting yourself
• swollen lymph nodes

Interferon beta-1b affects your immune system so it may increase your risk of developing a serious infection. Talk to your healthcare provider about the risks of using this medication.
Interferon beta-1b may cause other side effects. Call your healthcare provider if you have any unusual problems while using this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch] or by phone [1-800-332-1088].

Signs of infection

If you are receiving interferon beta-1b under your skin, you need to know the signs of an injection area infection (an infection at the area where you have given your medication subcutaneously). If you experience any of these signs near an injection area, call your healthcare provider as soon as possible:

• swelling
• lump
• pain
• irritation
• redness
• bruising
• drainage
• dark discoloration
• other skin problems

American Society of Health-System Pharmacists, Disclaimer

AHFS^® Consumer Medication Information. © Copyright, 2011. The American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP. 

Interferon β 1b                          Extavia

                                                                                   

Mitoxantrone                            Novantrone

Mitoxantrone Injection(mye toe zan' trone)

Last Revision: July 1, 2009.

Warning

Mitoxantrone should be given only under the supervision of a doctor with experience in the use of chemotherapy medications.
Mitoxantrone may cause a decrease in the number of white blood cells in the blood. Your doctor will order laboratory tests regularly before and during your treatment to check whether the number of white blood cells in your body has decreased. If you experience any of the following symptoms, call your doctor immediately: fever, chills, sore throat, cough, frequent or painful urination, or other signs of infection.
Mitoxantrone injection may cause damage to your heart at any time during your treatment or months to years after your treatment has ended. This heart damage can be serious and may cause death and can occur even in people without any risks for heart disease. Your doctor will examine you and perform certain tests to check how well your heart is working before beginning treatment with mitoxantrone and if you show any signs of heart problems. If you are using mitoxantrone injection for multiple sclerosis (MS; a condition in which the nerves do not function properly, causing symptoms such as weakness; numbness; loss of muscle coordination; and problems with vision, speech, and bladder control), your doctor will also perform certain tests before each dose of mitoxantrone injection and yearly after you have completed your treatment. These tests may include an electrocardiogram (ECG; test that records the electrical activity of the heart) and an echocardiogram (test that uses sound waves to measure your heart's ability to pump blood). Your doctor may tell you that you should not receive this medication if the tests show your heart's ability to pump blood has decreased. Tell your doctor if you have or have ever had any type of heart disease or radiation (x-ray) therapy to the chest area. Tell your doctor and pharmacist if you are taking or have ever received certain cancer chemotherapy medications such as daunorubicin (Cerubidine), doxorubicin (Doxil), epirubicin (Ellence), or idarubicin (Idamycin), or if you have ever been treated with mitoxantrone in the past. The risk of heart damage may depend on the total amount of mitoxantrone given to a person over a lifetime, so your doctor will probably limit the total number of doses you receive if you are using this medication for MS. If you experience any of the following symptoms, call your doctor immediately: difficulty breathing, chest pain, swelling of the legs or ankles, or irregular or fast heartbeat.
Mitoxantrone may increase your risk for developing leukemia (cancer of the white blood cells), especially when it is given in high doses or together with certain other chemotherapy medications.
Talk to your doctor about the risks of using mitoxantrone injection.

Show full warning

Why is this medication prescribed?

Mitoxantrone injection is used to decrease the number of symptom episodes and slow the development of disability in patients with certain forms of MS. Mitoxantrone injection is also used together with steroid medications to relieve pain in people with advanced prostate cancer who did not respond to other medications. Mitoxantrone injection is also used together with other medications to treat certain types of leukemia. Mitoxantrone injection is in a class of medications called anthracenediones. Mitoxantrone treats MS by stopping certain cells of the immune system from reaching the brain and spinal cord and causing damage. Mitoxantrone treats cancer by stopping the growth and spread of cancer cells.

How should this medicine be used?

Mitoxantrone injection comes as a liquid to be given intravenously (into a vein) by a doctor or nurse in a hospital or clinic. When mitoxantrone injection is used to treat MS, it is usually given once every 3 months for about 2 to 3 years (for a total of 8 to 12 doses). When mitoxantrone injection is used to treat prostate cancer, it is usually given once every 21 days. When mitoxantrone injection is used to treat leukemia, you will continue to receive this medication based on your condition and how you respond to the treatment.
If you are using mitoxantrone injection for MS, you should know that it controls MS but does not cure it. Continue to receive treatments even if you feel well. Talk to your doctor if you no longer want to receive treatment with mitoxantrone injection.
If you are using mitoxantrone injection for MS, ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

Other uses for this medicine

Mitoxantrone injection is also sometimes used to treat non-Hodgkin's lymphoma (NHL; cancer that begins in a type of white blood cell that normally fights infection). Talk to your doctor about the risks of using this medication for your condition.
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before using mitoxantrone injection,

• tell your doctor and pharmacist if you are allergic to mitoxantrone injection or any other medications.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention the medications listed in the IMPORTANT WARNING section. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have or have ever had any blood-clotting problems, anemia (decreased amount of red blood cells in the blood), or liver disease.
• tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while you are using mitoxantrone injection. Talk to your doctor about effective birth control methods that you can use during your treatment. If you become pregnant while using mitoxantrone injection, call your doctor immediately. Mitoxantrone injection may harm the fetus. If you are using mitoxantrone injection to treat MS, even if you are using birth control, your doctor should give you a pregnancy test before each treatment. You must have a negative pregnancy test before the start of each treatment.
• tell your doctor if you are breastfeeding. Do not breastfeed while you are using mitoxantrone injection.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are using mitoxantrone injection.
• you should know that mitoxantrone injection is dark blue in color and may cause the white parts of your eyes to have a slight blue color for a few days after you receive each dose. It may also change the color of your urine to a blue-green color for about 24 hours after you receive a dose.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?

Call your doctor right away if you are unable to keep an appointment to receive a dose of mitoxantrone injection.

What side effects can this medication cause?

Mitoxantrone injection may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• nausea
• vomiting
• diarrhea
• constipation
• heartburn
• loss of appetite
• sores on the mouth and tongue
• runny or stuffed nose
• thinning or loss of hair
• changes in the area around or under fingernails and toenails
• missed or irregular menstrual periods
• extreme tiredness
• weakness
• headache
• back pain

Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately:

• unusual bleeding or bruising
• small red or purple dots on the skin
• hives
• itching
• rash
• difficulty swallowing
• shortness of breath
• fainting
• dizziness
• pale skin
• yellowing of the skin or eyes
• seizures
• redness, pain, swelling, burning, or blue discoloration at the site where the injection was given

Mitoxantrone injection may cause other side effects. Call your doctor if you have any unusual problems while receiving this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch] or by phone [1-800-332-1088].

What other information should I know?

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to mitoxantrone injection.
Ask your pharmacist any questions you have about mitoxantrone injection.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

American Society of Health-System Pharmacists, Disclaimer

AHFS^® Consumer Medication Information. © Copyright, 2011. The American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.

                                                                                   

Natalizumab                             Tysabri

Natalizumab Injection(na ta liz' you mab)

Last Revision: May 10, 2011.

Notice

[UPDATED Posted 04/22/2011] FDA has updated the natalizumab (Tysabri) Prescribing Information to give new information about the size of the risk of progressive multifocal leukoencephalopathy (PML), a rare but serious brain infection, associated with use of natalizumab for the treatment of multiple sclerosis (MS) and Crohn's disease. The update includes new safety information about patients who have taken other drugs that suppress the immune system, who may be at a higher risk for PML. Natalizumab, in a class of medications called immunomodulators, has been approved by the FDA for the treatment of relapsing forms of multiple sclerosis since November 2004 and for the treatment of moderately to severely active Crohn's disease since January 2008. The revised label includes a table summarizing rates of PML with natalizumab use according to the number of infusions (how long the drug is taken or duration of exposure) and information on a newly identified PML risk factor. For more information visit the FDA website at: http://www.fda.gov/Safety/MedWatch/SafetyInformation and http://www.fda.gov/Drugs/DrugSafety.

Warning

Receiving natalizumab injection alone or with other medications that affect the immune system may increase the risk that you will develop progressive multifocal leukoencephalopathy (PML; a rare infection of the brain that cannot be treated, prevented, or cured and that usually causes death or severe disability). The more doses of natalizumab injection you receive, the greater the risk that you will develop PML.
Tell your doctor if you have or have ever had PML, an organ transplant, or another condition that affects your immune system such as human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), leukemia (cancer that causes too many blood cells to be produced and released into the bloodstream), or lymphoma (cancer that develops in the cells of the immune system). Also tell your doctor if you are taking any other medications that affect the immune system such as adalimumab (Humira); azathioprine (Imuran); cyclophosphamide (Cytoxan); cyclosporine (Neoral, Sandimmune); etanercept (Enbrel); glatiramer (Copaxone); infliximab (Remicade); interferon beta (Avonex, Betaseron, Rebif); medications for cancer; mercaptopurine (Purinethol); methotrexate (Rheumatrex); mitoxantrone (Novantrone); oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), prednisolone, and prednisone (Deltasone); sirolimus (Rapamune); and tacrolimus (Prograf). Your doctor may tell you that you should not use natalizumab injection.
You may need to have a magnetic resonance imaging scan (MRI; a scan that shows pictures of the inside of the body) before you begin treatment with natalizumab.
A program called the TOUCH program has been set up to help manage the risks of natalizumab treatment. You can only receive natalizumab injection if you are registered with the TOUCH program, if natalizumab is prescribed for you by a doctor who is registered with the program, and if you receive the medication at an infusion center that is registered with the program. Your doctor will give you more information about the program, will have you sign an enrollment form, and will answer any questions you have about the program and your treatment with natalizumab injection.
As part of the TOUCH program, your doctor or nurse will give you a copy of the Medication Guide before you begin treatment with natalizumab injection and before you receive each infusion. Read this information very carefully each time you receive it and ask your doctor or nurse if you have any questions.
Also as part of the TOUCH program, your doctor will need to see you every 3 months at the beginning of your treatment and then at least every 6 months to decide whether you should continue using natalizumab. You will also need to answer some questions before you receive each infusion to be sure that natalizumab is still right for you
Call your doctor immediately if you develop any new or worsening medical problems during your treatment. Be especially sure to call your doctor if you experience any of the following symptoms: weakness on one side of the body that worsens over time; clumsiness of the arms or legs; changes in your thinking, walking, balance, speech, eyesight, or strength that last several days; headaches; seizures; confusion; or personality changes.
If your treatment with natalizumab injection is stopped because you have PML, you may develop another condition called immune reconstitution inflammatory syndrome (IRIS; swelling and worsening of symptoms that may occur as the immune system begins to work again after certain medications that affect it are started or stopped), especially if you receive a treatment to remove natalizumab from your blood more quickly. Your doctor will watch you carefully for signs of IRIS and will treat these symptoms if they occur.
Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with infliximab injection and each time you receive the medication. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) or the manufacturer's website to obtain the Medication Guide.
Tell all the doctors who treat you that you are receiving natalizumab injection.
Talk to your doctor about the risks of receiving natalizumab injection.

Show full warning

Why is this medication prescribed?

Natalizumab is used to prevent episodes of symptoms and slow the worsening of disability in patients with relapsing forms (course of disease where symptoms flare up from time to time) of multiple sclerosis (MS; a disease in which the nerves do not function properly and people may experience weakness, numbness, loss of muscle coordination, and problems with vision, speech, and bladder control). Natalizumab is usually used by people who were not helped by other medications for MS or who cannot take these medications. Natalizumab is also used to treat and prevent episodes of symptoms in people who have Crohn's disease (a condition in which the body attacks the lining of the digestive tract, causing pain, diarrhea, weight loss, and fever) who have not been helped by other medications or who cannot take other medications. Natalizumab is in a class of medications called immunomodulators. It works by stopping certain cells of the immune system from reaching the brain and spinal cord and causing damage.

How should this medicine be used?

Natalizumab comes as a concentrated solution (liquid) to be diluted and injected slowly into a vein by a doctor or nurse. It is usually given once every 4 weeks in a registered infusion center. It will take about 1 hour for you to receive your entire dose of natalizumab.
Natalizumab may cause serious allergic reactions that are most likely to happen within 2 hours after the beginning of an infusion, but may happen at any time during your treatment. You will have to stay at the infusion center for 1 hour after your infusion is finished. A doctor or nurse will monitor you during this time to see if you are having a serious reaction to the medication. Tell your doctor or nurse if you experience any unusual symptoms such as those listed in the SIDE EFFECTS section, especially if they occur within 2 hours after the start of your infusion.
Natalizumab controls the symptoms of MS, but does not cure the condition. Keep all appointments to receive natalizumab even if you feel well.

Other uses for this medicine

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before using natalizumab,

• tell your doctor and pharmacist if you are allergic to natalizumab or any other medications.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention the medications listed in the IMPORTANT WARNING section. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have or have ever had any of the conditions listed in the IMPORTANT WARNING section. Before you receive each infusion of natalizumab, tell your doctor if you have a fever or any type of infection, including infections that last for a long time such as shingles (a rash that may occur from time to time in people who have had chickenpox in the past).
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using natalizumab, call your doctor.
• do not have any vaccinations without talking to your doctor.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?

If you miss an appointment to receive a natalizumab infusion, call your doctor as soon as possible.

What side effects can this medication cause?

Natalizumab may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• headache
• extreme tiredness
• joint pain or swelling
• pain in arms or legs
• swelling of the arms, hands, feet, ankles, or lower legs
• muscle cramps
• stomach pain
• diarrhea
• heartburn
• constipation
• gas
• weight gain or loss
• depression
• night sweats
• painful, irregular, or missed menstruation (period)
• swelling, redness, burning, or itching of the vagina
• white vaginal discharge
• frequent or painful urination
• sudden need to urinate right away
• difficulty controlling urination
• tooth pain
• cold sores

Some side effects can be serious. If you experience any of the following symptoms or those mentioned in the IMPORTANT WARNING section, call your doctor immediately:

• sore throat, fever, cough or other signs of infection
• rash
• hives
• itching
• difficulty breathing
• chest pain
• dizziness
• chills
• flushing
• yellowing of the skin or eyes
• nausea
• vomiting
• unusual darkening of the urine

Natalizumab injection may cause other side effects. Call your doctor if you have any unusual problems while using this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch] or by phone [1-800-332-1088].

What other information should I know?

Keep all appointments with your doctor.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

American Society of Health-System Pharmacists, Disclaimer

AHFS^® Consumer Medication Information. © Copyright, 2011. The American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP. 

                                                                                    

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004927/

Further information

This PubMed Clinical Q&A was reviewed by Susan Carson, MPH.
For the full report and evidence tables, please see:
Smith B, Carson S, Fu R, et al. Drug Class Review: Disease-modifying Drugs for Multiple Sclerosis: Final Update 1 Report [Internet]. Portland (OR): Oregon Health & Science University; 2010 Aug. Available at: http://www.ncbi.nlm.nih.gov/books/NBK50570/.

 

I was on Copaxone for the first few years that I was diagnosed.  Although a lot of people don't like the idea of having an injection every day, I preferred it because it was less to remember.  If there's an injection every day, there is no need to remember on which day the injection was.  However, after a couple of years, my doctor felt that I had more relapses than was acceptable to him.  There were also more new lesions showing up on my MRIs.

 

Because of this, my doctor felt that it was necessary to switch my medication.  I started taking Rebif.  As you can see from the information above, Rebif and Avonex are the same medication.  The difference is the dosage.  Rebif is a stronger dose of Avonex.

 

This medication was successful for a couple of years, until I had my last relapse...the worse one that I've had.  I blogged about my relapse when it was happening, in Jan/Feb '09.  After a treatment for the relapse finally worked, my doctor decided to switch my medication once again.  I am currently on Tysabri, which involves a monthly infusion.  Unbelievably, I haven't had a relapse in 2 1/2 years.

7.6.11 a lot of time has passed

I've been slack about my blogging and, like I've said before, I'm going to try to keep up with this.  Wow, it's been almost 3 months.

Soon after my last post, we went to Sandals in the Bahamas.  This is a part of a message I sent to a friend:

1. Using points from our credit card, I purchased 2 $100 spa certificates. Meaning that we would have $200 to spend solely at the spa - nails, massage, product, whatever. I checked with the front desk and they didn't have a record of these. I was told to check back later. I did and they still didn't have any record. This time I was told that I need to show them proof that I'd purchased these. I went to our room, got on the computer and searched for the email that I got from the credit card company. I found the email and put it on my phone to bring down to show the desk clerk. The email showed a purchase with points aned had something about the spa at the bottom of the email. They told me that this wasn't good enough proof. I'd had it...this was about the 4th trip to the front desk. We had concierge service so we went to their desk. We talked to one of the agents who called the universal Sandals office right away. She stayed on the phone until she got the bottom of the issue. We sent back to our room and she called us when she'd figured it out and put the credits on our account. It was ridiculous that we had to go to the front desk as many times as we did.

2. There was a dinner for the returning guests. We had a nice time and the food was pretty good. At one point during the meal we were told to reach under our chairs to see if there was anything attached to the underside of the seat. We were told that the whole table of the person who found it would win a prize. Jamie found something under his chair that said, “ Congratulations! You are the winner.” The person up front was asking who had gotten the prize. Our table was yelling that it was us. We were then told that the prize was a couples massage (apparently not for the whole table). Meanwhile, while our table was yelling, someone from another table was going up to the front to claim the prize. Turns out, there was a piece paper under his chair from another event. We had an employee from the resort , Yasmina, sitting at our table and she said that she would make sure that we would get our prize. We were psyched an went through the next couple of days knowing that we were going to have the massage on the second to last day, Sunday. On Saturday morning, we checked at the front desk to make sure that the credit had been applied. They checked with the spa and said that there was no record of it. Grrrrrr. We had to go talk to another person about what had happened to the credit. When we talked to him, he said that he was told that Yasmina had said that the paper was under her chair, which would have made the prize null and void. We told him that the paper was under Jamie’s chair and he told us that Yasmina wasn’t there that day so he would have to call her on her cell. Eventually, after a couple more visits, the issue was resolved and we got our prize.
3. We had a reservation at 8:00 pm for the Hibachi restaurant. Around 6:30 we started to think about getting ready.  Ynfortunately,the toilet was clogged.  Jamie called down to the front desk to let them know and was told that they would send someone up. I still had to take a shower before dinner (lots of sunscreen to wash off, etc.) so, of course, I was waiting for someone to come up before I hopped in the shower. About a half an hour to 45 minutes later, no one had shown up, so Jamie called again. They said, ‘Oh, no one has come? We’ll send someone right up.’ Around 7:40, I decided that I needed to take a shower regardless of what was in the toilet. As I was about to step in, the doorbell rang. Jamie told they guy that I was in the shower so he’d take care of the problem and bring the plunger back. To not drag out this story any longer, basically, we were late for our reservation because I was getting ready.

That's just a part of the issues that we had, but we had a great time, just the same.

May was basically uneventful.  From what I can remember now, so was June (until the 3rd week).  On June 24th, we left Burlington for Colorado to meet my nephew and support my sister while she was doing the MS Bike Ride in from Denver-Fort Collins-Denver.  Amazing!  So proud of my seester!  150 MILES!  Although we had a terrific time, it was by no means relaxing :)  Hanging with such an active 15 month old takes a lot of energy.  Here are some photos of Jack from our trip:

I think that is a good point to end it, for now, but this will certainly be continued,

4.19.11

It's been about a month since I've posted.  I know if I get out of the habit, it will only get harder to keep it up.  So, this will be brief.

I partictipated in the MS Walk on April 9th.  Unbelievably, I was able to raise over $6,000 this year.  Not as much as last year, but more than my goal.  And, I walked all 3 miles.

Tonight, Jamie and I went out to dinner with my parents at Three Tomatoes in Williston for my birthday...


k...sorry that's it...I'll try to update more soon.

3.26.11

The other day I had an appointment with my new neurologist.  As many of you may know, my previous neurologist, Dr. Hillel Panitch, died in December of Stage 4 Melanoma.

With the new doctor, Dr. Applebee, I was given a full neuro exam [which you all know now what that consists of :)].  I'm also going to be part of a trial which looks for the marker for the JC virus which can make patients taking Tysabri more prone to a potentially fatal brain disease.

Section Contents Menu
Drug Safety and Availability
Postmarket Drug Safety Information for Patients and Providers


Index to Drug-Specific Information Approved Risk Evaluation and Mitigation Strategies (REMS) Postmarketing Safety Evaluation of New Molecular Entities: Final Report Drug Safety Information for Healthcare Professionals- FDA Drug Safety Communication: Risk of Progressive Multifocal Leukoencephalopathy (PML) with the use of Tysabri (natalizumab)


Safety Announcement
Additional Information for Patients
Additional Information for Healthcare Professionals

Data Summary


Safety Announcement


[02-05-2010] The U.S. Food and Drug Administration (FDA) is alerting the public that the risk of developing progressive multifocal leukoencephalopathy (PML), a rare but serious brain infection associated with the use of Tysabri (natalizumab), increases with the number of Tysabri infusions received. This new safety information, based on reports of 31 confirmed cases of PML received by the FDA as of January 21, 2010, will now be included in the Tysabri drug label and patient Medication Guide (see Data Summary for additional information).


Tysabri was approved by the FDA in November 2004 for the treatment of relapsing forms of multiple sclerosis (MS). Tysabri is also approved by FDA for treating moderately to severely active Crohn's disease.


Since 2006, Tysabri has only been available through a risk minimization plan called Tysabri Outreach Unified Commitment to Health (the TOUCH™ Prescribing Program). The program, developed by the FDA and the manufacturer of Tysabri, Biogen-Idec, is intended to make sure that healthcare professionals and patients understand the benefits and potential risks associated with the use of Tysabri, including the risk of PML.Under the TOUCH™ program, every patient who receives Tysabri is closely monitored for the occurrence of PML and other serious opportunistic infections. For additional information about the TOUCH™ program click here1.


Based on the available information, the FDA believes that the clinical benefits of Tysabri continue to outweigh the potential risks. Revisions to the drug label and patient Medication Guide, with the continued use of the TOUCH Prescribing Program, are intended to maximize the safe use of Tysabri and the identification of new PML cases.


Additional Information for Patients


Tysabri is a medication that has been associated with PML and the risk of developing this disease increases with the number of Tysabri infusions received.


PML is a rare infection of the brain caused by the JC virus, which is a common virus often acquired during childhood. Most adults have been infected with JC virus, but do not develop PML. The virus appears to remain inactive until something (such as a weakened immune system) causes it to be reactivated. Once reactivated, the virus may infect the brain and cause PML.


People with a weakened immune system or people taking drugs that suppress their immune system (immunosuppressants) are most likely to get PML. Tysabri is an immunosuppressant medication.


The symptoms of PML may begin gradually, usually worsen rapidly, and vary depending on which part of the brain is infected. These symptoms may include difficulty with walking and other movements, decline in mental function, and problems with vision and speaking. Rarely, headaches and seizures occur. Symptoms of PML may be similar to multiple sclerosis (MS).


If PML is suspected, Tysabri treatment should be stopped and not resumed until further clinical evaluation is performed.


When patients have the clinical symptoms of PML, a PML diagnosis is made by an MRI of the brain and confirmation of the presence of JC virus in the cerebrospinal fluid.


Cases of Immune Reconstitution Inflammatory Syndrome (IRIS) have been reported after stopping Tysabri because of PML. IRIS is a condition that can occur after discontinuing immunosuppressant medications. During immune system recovery, patients can experience a severe inflammatory response to an infection and their symptoms can get worse, sometimes after a period of improvement.



Data Summary



The FDA continues to receive reports of PML in patients receiving Tysabri in the United States and overseas. Tysabri, an immunosuppressant medication, was first approved by the FDA in November 2004 for the treatment of relapsing forms of multiple sclerosis (MS). In February 2005, the marketing of Tysabri was suspended by the manufacturer after three patients in clinical trials (two patients in MS trials and one in a Crohn's disease [CD] trial) developed PML. In June 2006, the FDA approved an application for the re-marketing of Tysabri as monotherapy for the treatment of patients with relapsing forms of MS.


Tysabri is generally recommended for patients who have had an inadequate response to, or are unable to tolerate, an alternate MS therapy. In January 2008, Tysabri was also approved for inducing and maintaining a clinical response and remission in patients with moderately to severely active CD who have had an inadequate response to, or are unable to tolerate, conventional CD therapies.


Since July 2006 (when marketing resumed) through January 21, 2010, there have been 31 confirmed cases of PML worldwide in patients using Tysabri. Of these 31 case reports, 10 were from patients in the U.S. As of January 21, 2010, eight patients have died. In all cases, patients were receiving Tysabri as monotherapy for the treatment of MS. There have been no postmarketing reports of PML in patients treated with Tysabri for CD. In the U.S., less than 2% of Tysabri use is in patients with CD. Tysabri is not approved for CD outside of the U.S.


The risk of developing PML increases with the number of Tysabri infusions received. Tysabri is administered as a single intravenous infusion every four weeks. The overall worldwide cumulative rate of PML in patients who have received one or more Tysabri infusions is 0.5 cases of PML per 1,000 patients. Since Tysabri's re-marketing in the U.S., there have been no cases of PML in patients treated with Tysabri for less than 12 months. The overall worldwide cumulative rate of PML in patients who have received at least 24 infusions is 1.3 cases of PML per 1,000 patients. In the U.S., the cumulative rate of PML in patients who have received at least 24 infusions is 0.8 per 1,000 patients. Outside of the U.S., the cumulative rate of PML in patients who have received at least 24 infusions is 1.9 per 1,000 patients.


Approximately 66,000 people, worldwide, have received at least one dose of Tysabri since marketing resumption (through December 31, 2009). Relatively few patients have received 36 infusions or more, either in clinical trials or since marketing resumption; therefore, the magnitude of the risk of PML and other adverse events in patients who have received 36 infusions or more is not able to be well characterized.


The FDA and its international counterparts remain committed to tracking and monitoring for any change in the risk of PML associated with the use of Tysabri.


This communication is intended to increase awareness about the risk of PML in patients treated with Tysabri.At this time, the FDA believes that the clinical benefits of Tysabri outweigh its risks. Tysabri will remain available to patients through the TOUCH™ Prescribing Program. Under this program, every patient who receives Tysabri is closely monitored for the occurrence of PML and other serious opportunistic infections.

http://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders/ucm199872.htm

Fortunately, I have shown no signs of having developed this scary side effect and I'm closely monitored.


Two other follow-ups to the exam were the scheduling of an MRI and a blood draw.  Right after my appointment I went down to the phlebotomy lab to have my blood drawn. 


My doctor called me a couple of days ago to let me know the results of the blood panel.  Good news was that my white blood count and my liver function are good.  The downside, or the upside, depending on how you look at it, is that the blood tests showed that my vitamin D levels are really low.  I know...shocker, seeing as where we live.  Normal levels should be between 30 and 40.  My doctor likes to see her MS patients with levels around 50.  My vitamin D level is 5.  Apparently, this can have more of an effect on me than I realized.

Vitamin D Deficiency and related symptoms



Vitamin D deficiency can cause very dangerous disorders. Vitamin D deficiency symptoms are a warning sign that let’s you know something is not quite right. You need to make sure you are getting enough vitamin D from exposure to direct sunlight, vitamin D rich food and vitamin supplements.


Vitamin D deficiency symptoms appear more as various disorders. These symptoms include:


Rickets – It is the most frequent vitamin D deficiency symptom in children. As a result of vitamin D deficiency, the bones are weakened, the bone tissue fail to mineralize leading to soft and deformed bones.


Osteoporosis – It is a similar symptom to rickets, but it is found as vitamin D deficiency symptom in adults. Because of the low vitamin D level in the body there is deficient calcification in bones, which become brittle and soft.


Depression – According to scientist, depression is the result of the lack of vitamin D. They argue that because of urbanization, the sunlight can’t adequately reach the skin, reducing thus the 25(OH) level in the body, causing depression. It has been also discovered that a great number of people suffer from seasonal affective disorder during the winter due to insufficient exposure to direct sunlight. The parathyroid hormone is the one causing the vitamin D deficiency symptom – depression.


Hyperparathyroidism – Results from hypocalcemia, which is a blood condition with unusually low vitamin D level, resulting in hyperparathyroidism.


Fatigue – According to old remedies, sunshine and fresh air are essential for good health. The absence of vitamin D synthesis in the morning can result in fatigue.


Obesity – Vitamin D deficiency is frequently linked to obesity, as the insufficient level of vitamin D holds back the production of hormone leptin, which regulates the fat in the body. Inadequate exposure to sunlight disrupts the normal function of the body, determining the individual to eat more than it is necessary for the body.


The list of vitamin D deficiency symptoms also includes chronic backache, cancer, chronic pain, diabetes, multiple sclerosis, heart diseases or hypertension.

I've started taking vitamin D in the hopes of boosting my levels.  I've noticed issues with depression and fatigue.  Of course, this are also symptoms of MS so I'm not helping myself any by having a vitamin D deficiency.

Hmmm...I also just noticed chronic backache (check) and multiple sclerosis (check).

Thank you for letting me vent and express myself through this venue.  I really appreciate all of you that are reading this...I am very interested in helping my friends and family undertand this disease.

3.16.11 What Are the Symptoms of Multiple Sclerosis? (cont'd)

Yesterday, I described some of the symptoms that are common with MS and how they affect me.  I warned of the potential of TMI (too much information), but I ran out of time and energy before I made it to those particular symptoms.  Pretty sure that I'll get to them today, though.  As Charlie Sheen says, "you've been warned" [I promise that I'm really not a fan of his, but that line kind of seemed apropos].

Loss of sensations, speech impediment, tremors, or dizziness

I'm not entirely sure how numbness and loss of sensation differ, because I think that I sort of equate them as the same.  I suppose that numbness means that there is truly no feeling in that part of the body.  However, saying my feet are numb is a lot easier than saying, "I'm experiencing loss of sensation in my feet."  Let's see what the internet has to say...

Health Encyclopedia: Numbness And Tingling

Definition:  Numbness and tingling are abnormal sensations that can occur anywhere in your body, but are often felt in your fingers, hands, feet, arms, or legs.

Alternative Names:  Sensory loss; Paresthesias; Tingling and numbness; Loss of sensation

There are many possible causes:
•Remaining in the same seated or standing position for a long time.
•Injuring a nerve supplying the body part where you feel the sensation. If you have a neck injury, for example, you may feel the sensation anywhere along your arm or hand. Similarly, a low back injury can cause sciatica -- a sensation of numbness or tingling down the back of your leg.
•Lack of blood supply to the area. For example, plaque buildup from atherosclerosis in the legs can cause pain, numbness, and tingling while walking. (This is called claudication.)
•Pressure on the spinal nerves, as from a herniated disk.
•Carpal tunnel syndrome. This can cause numbness or tingling in your wrist, fingers, hand, or forearm.
•Certain medical conditions, including diabetes, underactive thyroid, multiple sclerosis, seizures, or migraine headaches.
•Abnormal levels of calcium, potassium, or sodium in your body.
•Vitamin B-12 deficiency.
•Transient ischemic attack (TIA) or stroke
•Certain medications.
•Toxic action on nerves, such as that from lead, alcohol, or tobacco.
•Radiation therapy.

...hmm, sounds to me like they're kind of the same.  Ok, let's move on to the next one.

I don't think that I've really had a problem with a speech impediment, except when I've had a relapse.  But, then everything kind of stops working so that makes sense.  The same goes for tremors.

I definitely notice dizziness on a daily basis.  Part of this probably has to do with the fact that this is a side effect of one of my medications.  During my last relapse, the one from just over 2 years ago, the major issues that were affecting me were numbness on one side of my face as well as my hands and feet, and dizziness.  With multiple treatments not working to end my relapse, I had an MRI taken.  I found it amazing that when I talked with my doctor, I was told that the lesions that were highlighting on my brain were in the areas that were responsible for my symptoms.  Of course, this makes sense, but it's cool to me that our brains are so well mapped out that if my doctors just looked at the MRI and not at me, that they would be able to tell what problems I was having.

Bladder and bowel dysfunction

Hello to the elephant in the room.  Unfortunately, I deal with this group of symptoms on a very regular basis.  I'm sure that you don't want to hear the gory details of my experiences on this front, so I'm going to turn to a generalized description of these symptoms.

Bladder and Bowel Dysfunction in Multiple Sclerosis

Bladder and bowel function impairments



Impairments in bladder function with MS are common and may affect up to 78% to 90% of patients during the course of multiple sclerosis (MS). The prevalence of bowel dysfunction in MS is estimated to be about 68% of patients. Bladder and bowel symptoms are relatively common in multiple sclerosis and can be treated. Goals for bladder and bowel management include maximizing independence and preventing incontinence and complications.

Bladder function


As with other MS symptoms, the kinds of bladder problems vary from person to person and can change over time. People may:

• have trouble controlling the release of urine (incontinence)
• experience frequent urges to urinate
• feel constant bladder fullness
• have difficulty in starting to urinate or in sustaining a steady stream
• In fact, some people may experience urinary retention and will require some form of catheterization. All these symptoms usually indicate problems in the functioning of the muscles that control urination, although urinary tract infection (UTI) must be eliminated as a cause.

An appointment with an advanced practice nurse or physician assistant to initially assess the bladder symptoms is helpful. Initial bladder assessment includes obtaining a thorough history from the patient and focusing on the primary concern.

You will be asked to void during the time of the appointment and urine volume will be measured. Please come to the appointment well hydrated with the need to void.

The specimen will be analyzed for a urinary tract infection through laboratory urinalysis (UA) and culture and sensitivity (C&S). We will also measure for a post-void residual amount with a bladder scanner in the office.

Some recommendations for treating bladder symptoms can be made after the initial assessment. However, if we are not able to help with your bladder symptoms or if you continue to experience frequent bladder infections you may be referred to a specialist in urology. The urologist can help evaluate the cause of the problem through evaluation of the upper and lower urinary tracts. Other treatment options may include Botox® or surgical interventions.

Do not try to self-treat your bladder problems by drinking less fluid! This can lead to constipation or urinary tract infections.

Bowel function


Bowel dysfunction is also a common symptom for patients with MS (Hinds et al., 1990). One study of 77 patients with clinically definite MS showed that bowel problems are not associated with bladder dysfunction, patient's age, degree of disability, or duration of disease (Chia et al.,1995).

The most common bowel complaint from a person with MS is constipation, but the most distressing bowel complaint is probably that of involuntary bowel/fecal incontinence. Because MS interrupts or slows the transmission of signals to and from the brain, the electrical impulses to the muscles that are involved in emptying your bowel can become disrupted.

Depending on your particular bowel problem helpful suggestions can be made. General interventions for bowel dysfunction include:

• Education about the causes of bowel dysfunction
• Encouraging dietary changes to include more fiber and fluid
• Consulting with your health care provider to adjust medication regimens that may be contributing to bowel dysfunction
• Establishing a regular bowel routine, individualized to the patient
• Encouraging regular physical activity
• Bladder and bowel symptoms are common in MS and can be effectively managed. Speak with your healthcare provider about what you can do to help keep these symptoms under control.

http://my.clevelandclinic.org/disorders/multiple_sclerosis/hic_bladder_and_bowel_dysfunction_in_multiple_sclerosis.aspx

Phew...that's out of the way.

Mental changes (decreased concentration, attention deficit, memory loss)

I was trying to post yesterday when Jamie got a phone call.  I was trying to post and was having a very hard time focusin on what I was writing.  I actually had to ask Jamie to leave the room because I couldn't concentrate.  I've also noticed that when I'm in a room with a group of people and trying to have a conversation with one person, I find that it is very difficult for me to zero in on the one person and not not hear everything else in the room.  It can be very distracting.

...this seems to be a good segue into attention deficit.  I imagine that decreased concentration and attention deficit go hand in hand.  Of course, as I write that, I'm thinking, "Well, no duh!"  Fortunately, the medication that I take to keep me awake, Provigil, is also prescribed for ADD.  At work this can work against me, though.  I'll be working and totally focused on what I'm doing and suddenly I realize that it's 2:30 and I haven't had anything to eat...all day.  Wait, what was I saying?

Memory loss...ooh boy, that's a big problem with me.  I don't think that most people understand what it means to have such a problem with memory.  When I talk with people that I know about the fact that I have such a problem in with my short term memory, I often hear, "I know what you mean.  It's tough getting older."  I don't know how to explain how it's different.  Ok, I'm going to turn to the internet again to help me explain.


MS & Memory Problems


X Genevieve Van WydenGenevieve Van Wyden began writing in 2007. She has written for “Tu Revista Latina” and owns three blogs. She has worked as a CPS social worker, gaining experience in the mental health system. Van Wyden earned her Bachelor of Arts in journalism from New Mexico State University in 2006.


By Genevieve Van Wyden, eHow Contributor


.Multiple sclerosis can cause more than physical degeneration of muscle function and abilities. MS can also cause the patient to develop problems with memory loss and cognitive degeneration. Processes such as storing and retrieving memories, processing information and remembering events can be affected. The ability to plan and prioritize can also be negatively impacted.

Cerebral MS


The link between multiple sclerosis (MS) and cognitive (memory) problems is well-known, with 70 percent of diagnosed cases of MS also featuring related memory-loss problems. 50 percent of patients diagnosed with early stage MS show related cognitive losses.

The most commonly found cognitive issues found in MS patients are in attention, memory, word-finding and abstraction. An increase in emotional lability (frequent, pronounced changes in mood) and slower information processing are also features of MS-related cognition issues.

When a person is experiencing severe cognitive issues related to MS, she is said to have "cerebral MS". Persons with this level of cognitive involvement often do not understand the severity of their memory loss issues.


Types of Memory Loss


Two types of memory loss related to MS are known: the first is recent memory loss, or that which affects things like remembering names and phone numbers, and when to take medications. MS most often affects this type of memory function.

The second type of memory loss is procedural or remote memory (how to use a computer or ride a bike). This kind of memory loss affects things and processes that were learned many years ago. MS does not have as much of an effect on this category of memory.


Effect on Executive Function


MS-related memory loss can have an effect on executive functions, which are the higher-level processes involved in more complex mental operations. These are prioritizing tasks, planning and the ability to problem-solve. Persons suffering from MS develop difficulty with this kind of function because it involves shifting from concept to concept and using mental quickness. They essentially feel lost in a maze.


Handling Memory Loss


The patient suffering from MS-related memory loss can rehabilitate his brain by going through rehabilitation to regain some cognitive functions. Some other ways he can handle memory loss include writing things down, using checklists, doing something when he thinks of the chore, putting objects in the same spot every time and prioritizing and focusing only on the most important tasks.


Use Electronic Memory Aids


The person with MS can utilize electronic memory aids such as the personal desk assistant (PDA). Cell-phone calendars can also help her to remember what she need so she can get through the day. Other devices such as tape recorders can also help, to record important information or a to-do list.

Read more: MS & Memory Problems
eHow.com http://www.ehow.com/about_5340874_ms-memory-problems.html#ixzz1GouxTsZS

Depression

Depression is common with MS.  There have been questions as to whether depression is a symptom of MS or because of the MS.  I think that it's probably a combination of both.  I also have problems with anxiety, so I take Zoloft.  I know that it definitely makes a difference, because on the days that I don't take it, either from forgetting or running out, I find that my fuse is shorter.

I have done my best to explain how the most common MS symptoms affect me.  I hope that it has helped many of you to understand a bit more.

If you have ANY questions, please comment on my blog.  Thanks so much for reading.

3.15.11 What Are the Symptoms of Multiple Sclerosis? (to be continued)

In the interest of helping my friends and family understand some of what living with MS is like, I'm going to be honest in explaining the symptoms and how they affect me. My apologies if this is TMI (too much information), but I'm letting you know what's in store so you can opt out now :)

Visual Disturbances (blurred vision, color distortions, loss of vision in one eye, eye pain)

I feel fortunate that I haven't had many issues with my vision, other than my initial diagnosis. In my first or second exaberation (the ones that helped to diagnose me), I had something called nystagmus:

Nystagmus most commonly causes the eyes to look involuntarily from side to side in a rapid swinging motion rather that staying fixed on an an object of person. Some nystagmuses, however, cause the eyes to jerk sideways or up and down.

Acquired nystagmus can be caused by a disease (multiple sclerosis, brain tumor, diabetic neuropathy), and accident (head injury), or a neurological problem (side effect of a medication).

http://www.allaboutvision.com/conditions/nystagmus.htm#ixzz1GiKvIAZn

I have had some other issues, but they have been infrequent. At one point, around the time of a relapse, I was having some symptoms where I was seeing wavy lines in front of one of my eyes. In a way, it looked kind of like a static-y tv set. The episode was brief and has only happened one other time.

Limb weakness, loss of coordination and balance

Usually, when my walking starts to be affected, I'm about to head into a relapse. I start to limp, caused by my right hip buckling. This is actually the main symptom that spurred my first visit to the neurologist. It was strange...I almost felt like I was walking that way intentionally...I can't really explain it. I knew that I couldn't help my distorted gait...perhaps I felt this way because it didn't feel like it was my leg. It kind of felt dettached from my body. For the past two years, my feet have been numb so I have become more familiar with the feeling when my leg starts to get 'wonky' and it doesn't feel quite so much like it's someone else's leg.

As for loss of coordination, I'm not sure that I lost any coordination, or it just got worse. I am constantly misjudging doorways and thinking that either I'm thinner than I am, or that the doorframe is wider than it is. I find bruises on my arms and legs from where I have cut a corner too sharply, resulting in running into a doorjamb, catching my thigh on the corner of a desk, etc. I used to be more concerned when I coudn't place how I'd gotten bruised. However, that is another symptom that I've grown used to as well.

In a previous post, I mentioned the different tests that make up a neurological exam. One of those tests is for Romberg's sign. This is tested by having the patient stand with feet together and then closing their eyes. The person doing the testing acts as a spotter, don't worry. I fail this one every time. A passing test would involve standing with feet together, eyes closed, and no swaying. A failing test results in swaying from left to right or, in my case, more like 'TIMBER' with a tree. To the right...every time.

Muscle spasms, fatigue, numbness, prickling pain
My experience with muscle spasms, or spasticity, has been minimal. There are some people who experience spasticity every day. In the past, I would wake up in middle of the night with major cramps in my calves. It would feel like the calf muscle had snapped and rolled up. My wonderful husband, Jamie, would massage my calves when ever this happened. Fortunately, I haven't had this problem for a while.

Another symptom that I had that was similar to spasticity was called tonic spasms.

One of the most common symptoms occurring in MS is neuro-muscular spasm. This troublesome symptom may be of two types, etiher tonic or clonic spasm.

Tonic spasm is when the resting muscle tone is abnormally increased. This is often simply apparent as stiffness, when the limb appears rigid and difficult to move despite the absence of absolute paralysis.

Clonic spasm: this is perhaps the most distressing of the two forms as the affected limb or muscle may jerk violently without warning, causing the individual to lose balance and perhaps fall.

I was at work one day at my desk, when suddenly the right side of my body went stiff and I couldn't move for a bit, probably about 30 seconds to a minute. My face contorted and my leg went stiff. This happened again when I was walking and I almost fell. I told my doctor about this, and I was told that this was called a tonic spasm and I was prescribed Tegratol, a medication usually used to treat epilepsy.
Fatigue is symptom that I deal with every day. I have a prescription for Provigil, more commonly used with ADHD. It also works to keep me awake during the day. I've found that if I forget to take my pill, or I've run out of my medication, I can't make it through work past noon. On those days that I have needed to leave, I've gone home and taken a 4 hour nap. Oddly enough, I take Ambien every night to help me sleep. It would seem that if I stopped taking both medications that I would be able to sleep at night and stay awake during the day. Unfortunately, it doesn't work that way.

Numbness has become a part of my daily life. My feet have been numb for the past two years, to the point of my not feeling comfortable driving. At times, I am so used to the feeling, or lack there of, that I forget that I can't feel my feet.

The prickling pain is called neuropathy. In a way, it's a combination of numbness and pain to the touch. That doesn't sound like it makes sense, but it's sort of like the feeling when your feet are asleep and they are waking up. There is a point at which your feet feel numb and painful at the same time.

So far, I've only accounted for about half of the symptoms that I listed in the previous post. I will continue to describe the symptoms and how I'm affected by them in my next post.

3.14.11 What are the types of Multiple Sclerosis? (cont'd)

What are the types of Multiple Sclerosis?

About a month after my stay in the hospital I had another exacerabation. This one involved Banding:

Banding is a symptom of multiple sclerosis in which someone feels as if they have a tight band around their chest or pressure on one side of their torso. The effect is sometimes referred to as the 'MS hug'. Some people experience a similar symptom in their hands or feet, where it feels as though they are constantly wearing gloves or boots.

The effect is an example of dysaesthesia or altered sensation which can also occur as pins and needles, burning sensations or numbness. The symptom occurs when messages from sensory nerves are blocked or disrupted. These symptoms are classed as a form of pain.

Although uncomfortable, the symptom usually passes without treatment. Some people find that creating an actual cause for a feeling of tightness (e.g. wearing tight clothing, or a close fitting top or a glove on the affected hand) can lessen the impact of the discomfort of the symptom.

Reference: Burgess M., Multiple sclerosis: theory and practice for nurses, London: Whurr; 2002

Since this was my second potential relapse, and would confirm a diagnosis, my doctor sent me for an MRI. This time the scan was of my cervical spine instead of my brain. The banding was along the line of my bra strap. The MRI showed a lesion right where I was feeling the 'MS Hug'.

This meant that I had a diagnosis of Relapsing-Remitting MS.


Multiple Sclerosis Treatment Medication

Since I had an official diagnosis, I could start medication. My options were Avonex, Betaseron, or Copaxone, all of which are injections, either daily or several times a week. Avonex and Betaseron are both interferons which are injected either subcutaneously or intra-mulscularly. An interferon works using a broad spectrum approach, meaning that the MS is not targeted directly. The most major side effects of interferons are flu-like symptoms. Usually by the time the patient has gotten over the side effects, it is time for the next injection.

I decided on Copaxone, a daily injection. Although it seems like you might want to have a break from sticking yourself with a needle, I preferred the regularity.

Q: How does COPAXONE (glatiramer acetate injection) work in my body?

A: COPAXONE is a unique therapy that is thought to work both outside and inside the central nervous system (CNS) to fight the effects of multiple sclerosis 3-5

COPAXONE is believed to work with your immune system to change the way it reacts to MS by both preventing harmful immune cells from developing and simultaneously stimulating the production of beneficial immune cells in your body. These "good" COPAXONE-activated cells then enter the CNS and help reduce inflammation and damage at the site of the lesions. 3

3. Miller A, Shapiro S, Gershtein R, et al. J Neuroimmunol 1998-92(1-2): 113-121 4. Ziemssen T, Kumpfel T, Klinkert WE, Neuhaus O, Hohfield R. Brain 2002: 125(Pt11): 2381-2391 5. Chen M, Valenzuela RM, Dhib-Jalbut S. J Neurol Sci. 2003:215(1-2): 37-44.

http://www.sharedsolutions.com/Get-Answers/copaxonefaqs.aspx

This all happened in 2002. Since then I have switched injections as well as taken other medications for the manifestations of MS. I'm going to keep that topic for another day.

If you have any questions or comments, you have an option to do so at the bottom of this post.

'til next time...