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Disease modifying therapy presentation
- 2. SEVEN DMT’S LICENSED IN THE U.K. • • • • • • • Avonex (beta interferon – 1a) Rebif (beta interferon – 1a) Betaferon (beta interferon – 1b) Extavia (beta interferon – 1b) Copaxone (glatiramer acetate) Tysabri (natalizumab) Gilenya (fingolimod)
- 3. INTERFERON BETA • Protein naturally produced by the human body • Help fight infections • Play important role in the functioning of the immune system • They work by blocking the action of gamma interferons who are thought to induce MS symptoms • They reduce the autoimmune reaction that results in inflammation and destruction of myelin
- 4. GLATIRAMER ACETATE • Thought that prevent the production of myelin reactive immune cells • Also, induces the generation of anti-inflammatory immune cells • Reducing the damage to myelin and nerve fibres
- 5. NATALIZUMAB • Prevent the passage of immune cells (white blood cells) across the blood-brain barrier • It is binding to a specific molecule on the immune cell surface preventing the attraction between the surface of these cells and the surface of the bloodbrain barrier • The drug prevents the migration of the immune cells into the central nervous system, where they can cause inflammation and damage
- 6. FINGOLIMOD • A specialised type of immune cell, called a T-cell is thought to be responsible for much of the damage caused in relapsing remitting MS • Acts by grabbing these T-cells from the blood stream and trapping them inside organs in the body called lymph nodes • This action prevents these T-cells from getting into the brain and causing damage
- 7. WHO ARE THESE DRUGS RECOMMENDED FOR? • People with relapsing remitting MS who have experienced at least two ‘clinically significant’ relapses in the last two years • People with secondary progressive MS who are still experiencing relapses, and where these relapses are the predominant cause of their increasing disability • People with ‘clinically isolated syndrome’, when MRI scans show a high likelihood that they will go on to develop MS • Children and young people with relapsing remitting MS
- 8. COMPARING THE DRUGS Interferon beta 1a Interferon beta 1a Interferon beta 1b Interferon beta 1b Biogen Idec Merck Serono Rebif Betaferon Bayer Schering S.C Alternate days S.C Bayer Schering/Nov artis Alternate days S.C 1 x week 3 x week I.M Pre-filled syringe and bio-set Yes No No Yes Pre-mix 2-8°C single vial at room temp up to 1 wk. Bio-set room temp up to 2 yrs Yes In fridge between 28°C At room temp At room temp In fridge between 28°C or at room temp for up to 1 month Yes Yes Yes No Flu-like symptoms Flu-like symptoms Flu-like symptoms Flu-like symptoms Changes in menstruation/ periods, blood abnormalities, neurological symptoms, mood changes Changes in menstruation/ periods, blood abnormalities, neurological symptoms, mood changes Changes in menstruation/ periods, blood abnormalities, neurological symptoms, mood changes Changes in menstruation/ periods, blood abnormalities, neurological symptoms, mood changes Injection site reactions and lipoatrophy Chest tightness, breathlessne ss, anxiety, flushing, palpitations. Typically last a few minutes. Avonex Manufacture r How often Is it given How is it injected Does it come premixed Storage Regular blood tests Common side effects Less common side effects Extavia Glatiramer acetate Copaxone Teva Every day S.C
- 9. SIDE EFFECTS • Flu- like symptoms • Site injection problems • Mood changes • Neurological symptoms • Changes in menstrual periods • Liver function and blood count
- 10. NEUTRALISING ANTIBODIES • Sometimes the body’s immune system begins to react against beta interferon by producing antibodies which might prevent the drug from being effective • This can be checked by a blood test • In some cases level of antibodies go down over time • Sustained, high level of neutralising antibodies might suggest that the drug is no longer effective, and can be a factor in choosing to stop treatment
- 11. STOPPING THE DRUGS • Due to any signs of a serious side effect or adverse reaction • If the side effects are intolerable • If you are planning to get pregnant • If you develop an increased number and severity of relapses • If you do not see a reduction in the number of relapses compared to the one to two years before you started taking it • If you develop ‘neutralising antibodies’ • If you develop secondary progressive MS and can no longer walk • If a more suitable treatment becomes available
- 12. SWITCHING DRUGS • Yes, you can switch to another drug that you are eligible for • Note that if you switch from a beta interferon because of neutralising antibodies, it only makes sense to switch to glatiramer acetate as the bodies will neutralize other forms of interferons as well
- 13. INJECTION • Subcutaneous (under the skin) or intramuscular (into the muscle) • ‘Auto-inject’ – a system where you cannot see the needle and the action of injecting comes down to the click of the ‘pen’ holding the syringe • Rebif – uses ‘RebiSmart’- a device using pre-filled syringe cartridges which only need loading once a week • A nurse will teach you the good injection technique
- 14. STORAGE • Different drugs have different storage requirements • Most need to be kept in the fridge • Also, you will need a safe space to store syringes and discarded needles • The drug company will supply a box for these discarded ‘sharps’
- 15. TRAVELLING • A travel bag will be given when you start the treatment, with ice packs • All drugs can be stored at the room temperature for a limited period of time • In case of delays in travelling you should have few more doses with you • Air travel- keep your travel bag in the cabin; contact them in advance to inform about medication; your MS nurse can provide you with a letter to explain the need to travel with your drug; also, the drug company can provide you with paperwork to help with travel
- 16. FURTHER INFORMATION • MS Society • MS Decisions • National Institute for Health and Clinical Excellence (NICE) • MS UK • MS Trust • • Association of British Neurologists (ABN)