How to Reduce the Pain of Injections

Self-injectable medications

Several of the medications used to treat multiple sclerosis are injectable drugs. The requirements for storage and administration differ for each drug, but here are some universal tips that will help reduce the pain of the injections. Please note that if you have questions or difficulties with a specific drug, call the drug company’s helpline or ask your own MS nurse for help.

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Room temperature medication

Medications which must be kept in the refrigerator for storage are often much less painful upon injection when at room temperature. Before injecting, remove one pre-filled syringe from the refrigerator and leave the syringe out for at least 30 minutes before using. Or alternatively, while still in the wrapper, hold it in your armpit to bring it to body temperature.

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7 Tips To Reduce the Pain of Injections

Staying With Rituxan Rather Than Switching to Ocrevus

The latest disease-modifying therapy, called Ocrevus (ocrelizumab), was approved in March 2017 for relapsing and primary progressive forms of MS. Ocrelizumab works differently than other DMTs for MS in that it selectively depletes B-cells. B-cells are a type of white blood cell that develops antibodies in response to specific antigens, a process which helps the immune system to fight invaders. However, abnormal B-cells may mistakenly produce autoantibodies that contribute to autoimmune diseases such as multiple sclerosis, rheumatoid arthritis (RA), lupus, or scleroderma.

Ocrevus is very closely related to the drug Rituxan (rituximab) which is used to treat certain autoimmune diseases, such as rheumatoid arthritis and myasthenia gravis, as well as cancers like non-Hodgkin’s lymphoma and chronic lymphocytic leukemia. Both therapies work in the same way to alter the immune system. Rituxan is also commonly used off-label to treat MS, and I have personally used it since 2009.

Ocrelizumab specifically targets and destroys CD20+ B-cells in a way that serves to lower the immune system. Studies of ocrelizumab demonstrated that it could reduce relapses by 46 to 47 percent in people with relapsing MS compared to treatment with subcutaneous interferon beta-1a. People with primary progressive MS (PPMS) who received ocrelizumab were 24 percent less likely to experience disability progression than those who received placebo in a clinical study.

Ocrelizumab is an intravenous infusion therapy which is delivered twice a year in an infusion center or doctor’s office. The first dose is divided in half and given as two separate infusions, two weeks apart. Pre-medications, such as corticosteroids and an antihistamine, are given in advance to reduce the risk of infusion-related reactions that may include itchy skin, hives, coughing or wheezing, throat irritation, flushing, shortness of breath, dizziness, or fatigue. Since ocrelizumab weakens the immune system, patients are at greater risk of developing infections. Additional risks include reactivation of the hepatitis B virus and progressive multifocal leukoencephalopathy.

The decision to switch treatment or not

The MS community has received ocrelizumab with excitement and open arms. I personally know several people who have either switched to Ocrevus already or are considering it. Several factors come into play when making treatment decisions, including comparing efficacy, side effects, impact on lifestyle, and insurance coverage. Twelve years ago, MS patients would choose a treatment and stick with it, even if their disease remained active. Now, patients have options and may switch DMTs when their disease fails to reach NEDA (no evidence of disease activity).


Like many people living with multiple sclerosis, I am determined to do all I can to slow down the disease. Although I might not always exercise as much as I should or I might indulge in rich food on occasion, I still try to focus on healthy lifestyle habits and reduce stress. An important part of fighting this disease for me is to consistently use a disease-modifying therapy.

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Why I Am Not Considering Ocrevus?

Using Disease-Modifying Therapies to Slow Down Multiple Sclerosis

Currently available disease-modifying therapies (DMTs) are primarily used in relapsing forms of the disease, including relapsing-remitting MS (RRMS), secondary-progressive MS (SPMS) in patients still having relapses, and progressive-relapsing MS (PRMS). Some DMTs are also approved for delaying a second exacerbation in people who have been diagnosed with clinically isolated syndrome (CIS). One DMT has been approved for primary progressive MS (PPMS).

Disease-modifying therapies (DMTs) can be grouped together in a variety of ways. They can be categorized as oral drugs, self-injectables, or infusible medications; or they may be identified by their mechanism of action (MOA, or how they work). DMTs can also be divided into so-called first-line agents, which are common initial treatment choices for people diagnosed with MS, or second-line agents, which are typically reserved for patients who have not responded adequately or are unable to tolerate first-line drugs.

Self-injectable DMTs

Self-injectable disease-modifying therapies considered to be first-line options include Avonex (interferon beta-1a), Rebif (interferon beta-1a), Betaseron (interferon beta-1b), Extavia (interferon beta-1b), Copaxone (glatiramer acetate), and Glatopa (glatiramer acetate). Interferon beta drugs are FDA- approved to treat all relapsing forms of MS. With the exception of Rebif, interferon beta drugs are also approved for use in CIS. Copaxone is a synthetic polypeptide agent which is approved for RRMS and CIS. An additional injectable medication includes Plegridy (pegylated interferon beta-1a).

Oral DMTs

Since 2010, three oral therapies, each with different mechanisms of action, have been approved by the FDA for treatment of relapsing forms of MS. Gilenya (fingolimod) is the first in a new class of oral MS medications, called sphingosine 1-phosphate receptor modulators, which suppress lymphocyte circulation in the immune system. Two other agents in this class are currently in clinical trials. Aubagio (teriflunomide) is also the first in a new class of oral MS medications called pyrimidine synthesis inhibitors which have anti-inflammatory and immunoregulatory properties that have been used to treat rheumatoid arthritis and psoriatic arthritis. Tecfidera (dimethyl fumarate) is in a class of drugs called Nrf2 activators believed to have anti-inflammatory and cytoprotective properties.

Intravenous DMTs

Intravenous therapies include Tysabri (natalizumab), Ocrevus (ocrelizumab), Lemtrada (alemtuzumab), and Novatrone (mitoxantrone) which are typically reserved as second-line treatment choices. Tysabri, a humanized monoclonal antibody that binds to alpha-4 integrin and inhibits T-cells from crossing the blood-brain-barrier, is administered every 4 weeks by specially trained healthcare providers. Tysabri is approved for relapsing forms of MS and is highly effective, but carries the risk of a serious brain infection called progressive multifocal leukoencephalopathy (PML). Ocrevus, a humanized monoclonal antibody that binds to and depletes CD20+ B-cells, is administered twice a year with the first dose split into two infusions. Ocrevus is associated with infusion-related reactions and increased risk of breast cancer.

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Slowing Down Long-Term Progression of Multiple Sclerosis With Disease-Modifying Therapies

Fear of Change: A Relapsing MS Moment

There is nothing predictable or constant with multiple sclerosis. People living with the disease may have periods of time where not much seems to be going on. Other times, there may be relentless relapses that leave neurological debris in their wake. The high degree of adaptability required to mentally and physically handle these changes is tremendous.

Stability is a welcome blessing when it comes to living with MS or any other chronic disease. With stability comes some level of predictability. However, it doesn’t prevent the potential rollercoaster that changes, of any sort, may cause.

I’ve enjoyed a sense of stability for years now. In fact, I’ve only had one major relapse since December 2011 that occurred in February 2016. One reason for this streak of “luck” is a treatment that has proven to be effective for me. I’m what you would call a “responder” to the medication rituximab.


Recently I’ve encountered a threat to access of that same medication. Since I’ve been sick so many times during the past year, my doctor has ordered laboratory tests to check for levels of specific immune system components, called immunoglobulins. I don’t have the results yet; but based on concern for a potential immunodeficiency, my doctor has delayed my next round of infusions until we know more.

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MS Moment: The Recurring Fear of Change

Personalized Treatment for MS or Herd Mentality: What Does Your Neurologist Do?

People diagnosed with multiple sclerosis (MS) and their neurologists must make many decisions when it comes to treating the disease. With FDA-approved disease-modifying therapies, it can be challenging to know which one to use, if any.

How do doctors and patients choose? To make an informed decision, neurologists are expected to follow clinical practice guidelines that frequently summarize the available medical evidence. Meanwhile, patients are expected to do their own research and consider lifestyle factors and personal preference, as well as doctor recommendations.

It’s clearly unwise for neurologists to follow outdated clinical guidelines; consider that when the American Academy of Neurology (AAN) published its guidelines in 2002, only four treatment options were available. A less obvious concern is when neurologists ignore current clinical guidelines and instead follow the recommendations of other neurologists they know or experts in the field, a behavior called “herding.”

Herding can be detrimental to patient care, suggests a study published in January 2017 in the journal Patient Preference and Adherence.

What is herding in medicine?

Herding is a phenomenon in which individuals follow the behavior of others rather than making a decision independently. Herding occurs in MS care when one neurologist follows the therapeutic recommendation of a colleague even when this advice is not supported by clinical guidelines.

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Does Your Multiple Sclerosis Specialist Follow the Herd?

What is Aggressive Onset MS?

Multiple sclerosis is a disease which affects people in many different ways. For some, it can be relatively mild, while for others it can be very aggressive and cause high levels of disability in a short period of time. The more aggressive presentation of MS has been called “malignant MS” or “highly active MS” or simply “aggressive MS.” This type of MS would be different from advanced MS, in that disability accumulates very quickly, up to Expanded Disability Status Scale (EDSS) score 6.0, within the first few years after diagnosis. Patients with aggressive onset MS, or AOMS, may have smaller windows of opportunity for receiving the most effective treatment to slow down the disease.

Studying aggressive onset MS (AOMS)

To date, there are no established criteria or biomarkers by which neurologists can easily identify cases of aggressive MS. To learn more about this type of MS, researchers in New York reviewed the published literature to carefully select a set of criteria with early clinical features and MRI findings that doctors can use to identify these cases. They published their findings in August 2016 in the Journal of Neuropsychiatric Disease and Treatment. The criteria included: 1) two or more relapses in the year after disease onset and two or more gadolinium-enhancing lesions on brain MRI scans; or 2) one relapse if it results in sustained disability (at least EDSS 3.0) along with two or more gadolinium-enhancing lesions.

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Aggressive MS Needs Early Aggressive Treatment

What To Know About Zinbryta

Disease-modifying therapies (DMTs) are important tools in the fight against multiple sclerosis. To date, the U.S. Food and Drug Administration (FDA) has approved 14 DMTs: 13 therapies for the treatment of relapsing forms of MS, some of which are also approved for clinically isolated syndrome; and one therapy, Novantrone, for the treatment of “worsening MS;” however, Novantrone is no longer customarily used in the United States.

In May 2016, daclizumab (under the brand name, Zinbryta) was approved by the FDA as the fourteenth DMT option for people diagnosed with MS in the U.S. In July 2016, Zinbryta was approved for use in Europe. The FDA suggests that because of its safety profile, the use of Zinbryta should generally be reserved for patients who have had an inadequate response to two or more drugs indicated for the treatment of MS.


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What You Need to Know About the Latest MS Drug Zinbryta

Ocrevus Receives Breakthrough Therapy Designation

Genentech and Roche announced that the Food and Drug Administration has granted Breakthrough Therapy Designation for the investigational medicine ocrelizumab (Ocrevus™) for the treatment of people with PPMS. Breakthrough Therapy Designation is designed to expedite the development and review of medicines intended to treat serious or life-threatening disease and for which preliminary clinical evidence suggests that the drug may demonstrate substantial improvement over existing therapies. Remember that PPMS has no approved therapies.

Breakthrough Therapy Designation was granted to ocrelizumab based on positive results form a pivotal Phase III study (called ORATORIO) which showed treatment with ocrelizumab significantly reduced disability progression and other markers of disease activity compared with placebo in patients with PPMS. Top-line results were of ORATORIO were presented at the 31th ECTRIMS conference in October 2015.

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FDA Grants Breakthrough Therapy Designation to Treatment for Primary Progressive MS

Positive Trial Results for Ocrelizumab in Primary Progressive MS

After lots of hype and buildup ahead of the conference, the pharmaceutical company Roche-Genentech finally revealed a bit more than simply “positive results” from three pivotal Phase III studies of the experimental MS therapy ocrelizumab in relapsing MS and primary progressive MS (PPMS). While relapsing MS has 13 approved therapies and other treatments which are used off-label, such as rituximab, effective treatment for PPMS has continued to be elusive.

What is ocrelizumab?

Ocrelizumab is a humanized (10 percent mouse, 90 percent human-derived) monoclonal antibody designed to target a selective group of immune cells - CD20+ B-cells - which have been implicated in the damage of myelin, the fatty substance that protects nerve cells and helps to speed the transmission of nerve signals throughout the body. In clinical trials, ocrelizumab 600 mg was administered by intravenous (IV) infusion every six months, given as two 300 mg infusions spaced two weeks apart in the ORATORIO trial, while repeat rounds in the OPERA I and II trials were given as a single 600 mg dose infusion.

Ocrelizumab works in the same way as rituximab (Rituxan), a chimeric (100 percent mouse-derived) monoclonal antibody that attaches to CD20 cell surface proteins and causes certain B-cells (but not stem cells or plasma cells) to self-destruct. Rituxan is used to treat rheumatoid arthritis (RA), non-Hodgkin’s lymphoma (NHL), chronic lymphocytic leukemia (CLL), granulomatosis with polyangitis (GPA) and microscopic polyangitis (MPA). Rituxan is also used off-label for a number of other autoimmune diseases including MS and neuromyelitis optica (NMO). Patents protecting Rituxan (jointly marketed by Genentech and Biogen) from generic competition begin to expire in 2015.

Read this post in its entirety:
Is Ocrelizumab The Next Game-Changer in MS Treatments?

Alemtuzumab and Infusion Reactions

Lemtrada (alemtuzumab 12 mg) is a humanized monoclonal antibody, targeting CD52+ T and B cells, delivered by IV infusion on five consecutive days (course 1) followed by another three consecutive days one year later (course 2). Lemtrada has been approved in several countries for treatment of relapsing-remitting multiple sclerosis (RRMS) and is generally reserved for people with MS who have failed other treatments.

In clinical trials, infusion-associated reactions (IARs) affected 90.1 percent of patients receiving alemtuzumab. The most common IARs were headache, rash, fever (pyrexia), nausea, and flushing; most were mild to moderate in severity. The two main types of IARs are allergic (hypersensitivity) and nonallergic (cytokine release) reactions.

IARs were more frequent during course 1 than during course 2 of treatment; IARs occurred in 84.7-96.3 percent of patients during course 1 compared with 68.6-81.9 percent of patients during course 2. In each treatment course, the greatest numbers of IARs occurred with the first infusion and decreased with each infusion thereafter.

Management of IARs

Nurses play an important role in the detection and management of IARs. Best practices for management of IARs associated with Lemtrada include patient and caregiver education, prophylactic medication—particularly corticosteroids, antihistamines, and antipyretics—to reduce IAR severity, infusion monitoring, and discharge planning.

Severe IARs can generally be managed by slowing the infusion rate or by temporarily stopping the infusion, allowing time for recovery of symptoms, and then restarting at a slower rate.

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Prevention of Infusion Reactions with Lemtrada

Novartis Obtained MS Rights to Ofatumumab

What is ofatumumab?

Ofatumumab is a B-cell depleting monoclonal antibody therapy that targets CD20+ B-cells. Multiple sclerosis is known to be affected by T-cell activity, but is increasingly understood to be connected to B-cell activity in the immune system. B-cells are lymphocytes produced in the bone marrow.

B-cell depleting therapies and MS

Each of the investigational therapies that target CD20+ B-cells are cytotoxic, meaning that they bind to CD20 receptors on the cell surface and cause the cell to self-destruct. The rapid depletion of these specific B-cells is proving to be an effective treatment for MS.

Ofatumumab (Arzerra), a fully human MAB, has been studied in a small Phase IIa clinical trial involving 38 patients with relapsing-remitting MS. Results from the trial showed that intravenous ofatumumab (at each of three different doses being tested, given by infusions separated by two weeks) reduced total number of new brain lesions by up to 90% in 4-12 weeks. Compared to placebo, ofatumumab did not increase serious adverse events; however two patients in the 300-mg dosage group dropped out of the study because of adverse events. In light of these positive results, ofatumumab should be ready to move into Phase 3 trials.

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Novartis to Pay GSK $1B+ for Ofatumumab to Treat MS

Maximize Your Treatment Value

1. Choose medication that fits your lifestyle and priorities.
With 13 disease-modifying therapies available, MS patients and neurologists in the US have more options than ever to slow down progression of the disease. Before choosing a medication, it is important to evaluate the benefits and risks of each option to determine which one(s) more closely matches your personal needs, priorities, and concerns. Don’t forget to factor in your lifestyle preferences as you will only gain the greatest benefit from a treatment plan if you are able to follow it as directed.

2. Use medication as directed.
With each new medication you are prescribed, it is important to understand how the drug should be taken (what time of day/week/month to take it, with food or without, and for how long); potential side effects and what to do if you experience them; what to do if you miss a dose; and are there certain foods, alcohol, dietary supplements, or other medications to avoid while taking the prescribed medication. For each MS medication, there are patient guides available that explain some of this information, but don’t be shy about asking your doctor and/or pharmacist for more information.

3. Keep a symptom, medication and side-effect diary.
Especially important when you are first getting into the habit of using a new medication is to keep track of how you are using the medication, including any problems you experience. Many MS drug manufacturers provide physical diaries and/or smart device apps that help make this task easier. With your first MS drug, patients are encouraged to document where they gave themselves injections and rotate injection sites appropriately. With careful documentation, you can look back on your notes to look for patterns that may help you improve the way you use medication.

4. Take advantage of drug company programs.
Drug companies that manufacture disease-modifying therapies for MS typically offer programs to patients. These programs range from on-call nurses who answer your questions, free print or electronic materials, and financial assistance to help pay for treatment, to local programs where patients can learn more about treatment options, ask trained medical professionals questions, and socialize with other patients. Taking advantage of these programs is one way that you can become a more educated and equipped patient to make informed treatment decisions.

5. Keep your doctors informed as well.
Always tell your doctors/nurses/healthcare professionals what medications, OTC drugs, and dietary supplements you are using. Keep an updated list in your purse or wallet which can be easily accessed and shared. If you see multiple doctors, schedule time with your primary care doctor or a clinical pharmacist to take a big picture look at your health needs and to optimize your treatment plan(s). Also tell your doctor if you are pregnant, breastfeeding, or intend to become pregnant in the near future; use alcohol or tobacco; have other health conditions; have food or other allergies, or follow a restricted diet.

Read this post in its entirety:
Five Ways to Get the Most Out of Your MS Medication

(photo credit: deathtothestockphoto.com)

12 FDA-Approved Treatments for Relapsing Multiple Sclerosis

As of February 2015, members of the relapsing MS community in the US may choose from twelve FDA-approved disease-modifying therapies (DMTs) to slow down the long-term progression of the disease by reducing relapses, number of lesions, and accumulation of physical disability.

Many of the DMTs detailed below are prescribed for people with relapsing forms of MS, including relapsing-remitting MS, as well as secondary-progressive MS and progressive-relapsing MS in those people still having relapses. Select DMTs have also been approved to delay a second exacerbation in people who have been diagnosed with clinically isolated syndrome (CIS).

So far, no DMTs have proven to be effective in progressive forms of MS without relapses.

Oral therapies:

• Aubagio (teriflunomide, 7 mg and 14 mg; pyrimidine synthesis inhibitor) is taken once daily by mouth for relapsing forms of MS; approved in 2012. Sanofi-Genzyme: aubagio.com, msonetoone.com
• Gilenya (fingolimod, 0.5 mg; sphingosine 1-phosphate receptor modulator) is taken once every day by mouth for relapsing forms of MS; approved in 2010. Novartis: gilenya.com
• Tecfidera (dimethyl fumarate, 240 mg; Nrf2 activator) is taken twice daily by mouth for relapsing forms of MS; approved in 2013. Biogen Idec: tecfidera.com, msactivesource.com

Injectable therapies:

• Copaxone (glatiramer acetate, 20 mg/mL and 40 mg/mL; synthetic polypeptide) is taken by subcutaneous injection every day (20 mg dose) or three days each week (40 mg dose) for CIS and relapsing forms of MS; approved in 1996; auto-injector available. (Generic options may become available soon.) Teva Neuroscience: copaxone.com, sharedsolutions.com
• Avonex (interferon beta-1a, 30 mcg/.5 mL) is taken once weekly by intramuscular injection for CIS and relapsing forms of MS; approved in 1996; auto-injector and dose titration available. Biogen Idec: avonex.com, msactivesource.com
• Betaseron (interferon beta-1b, 0.25 mg/mL) is taken every other day by subcutaneous injection for CIS and relapsing forms of MS; approved in 1993. Solution must be mixed before injection. Bayer HealthCare: betaseron.com
• Extavia (interferon beta-1b, 0.25 mg/mL) is taken every other day by subcutaneous injection for CIS and relapsing forms of MS; approved in 2009. Solution must be mixed before injection; dose titration available. Novartis: extavia.com
• Plegridy (peginterferon beta-1a, 0.125 mg/.5 mL) is taken every 14 days by subcutaneous injection for relapsing forms of MS; approved in 2014; auto-injector available. Biogen Idec: plegridy.com, msactivesource.com
• Rebif (interferon beta-1a, 22 mcg/.5 mL and 44 mcg/.5 mL) is taken three days each week by subcutaneous injection for relapsing forms of MS: approved in 2002; auto-injector and dose titration pack available. EMD Serono/Pfizer: rebif.com, mslifelines.com

Infusion therapies:

• Lemtrada (alemtuzumab, 12 mg; CD52 monoclonal antibody) is delivered by intravenous infusion on five consecutive days, followed by another three consecutive days one year later, for relapsing forms of MS and generally reserved for people with MS who have failed other treatments; approved in 2014. Sanofi-Genzyme: lemtrada.com
• Novantrone (mitoxantrone, 140 mg; antineoplastic anthracenedione) is delivered by intravenous infusion once every 3 months with a lifetime maximum limit of 8-12 doses over 2-3 years for worsening relapsing-remitting MS, progressive-relapsing MS, or secondary-progressive MS; approved in 2000. Available as generic drug since 2006. EMD Serono/Immunex Corp.
• Tysabri (natalizumab, 300 mg; α4β1-integrin monoclonal antibody) is delivered by intravenous infusion once every four weeks at a registered infusion center for relapsing forms of MS; approved in 2006. Must not be combined with other disease-modifying therapies. Biogen Idec: tysabri.com, msactivesource.com

If one DMT doesn’t work for you, or is intolerable, discuss other options with your neurologist.

Republished from:
MS Patients Have 12 Disease-Modifying Therapeutic Choices

Plegridy Available in the US

Late Friday afternoon, August 15, 2014, the Food and Drug Administration (FDA) gave Biogen’s PlegridyTM (peginterferon beta-1a) a green light (i.e., approval) for use in relapsing forms of multiple sclerosis. This new drug, basically an improvement on two longtime gold standard medications, Avonex and Rebif, is a longer-acting formulation of interferon beta-1a that is given by subcutaneous (under the skin) injection every two weeks, compared to Rebif’s subcutaneous injections three days each week and Avonex’s intramuscular injection once weekly.

Plegridy was approved in Europe on July 23, 2014 for treatment of relapsing-remitting MS (RRMS). It comes in a prefilled syringe or a new ready-to-use autoinjector called the Plegridy Pen.

In July, Mat Hesser, Director of Biogen Idec’s Patient Center of Excellence, told me that Biogen will continue to produce Avonex  but may spend less time actively promoting it. As Biogen now offers four of the eleven drugs approved for MS, in addition to Fampyra outside the US, they are undoubtedly the leading MS-focused pharmaceutical company serving the MS community worldwide.

During our discussion, I mentioned to Mat an ongoing concern that there is lack of awareness for financial assistance programs in the US to help patients access treatments. I am pleased to see that Biogen’s press release regarding Plegridy’s approval clearly references Biogen’s patient support programs, including financial support, available through MS ActiveSource. [Disclaimer: I have served as a patient advisor to Biogen in recent years reviewing educational and support materials developed for MS patients.]

Visit PLEGRIDY.com for complete prescribing information. MS ActiveSource is available via phone (Monday-Friday 8:30 a.m. – 8:00 p.m. ET) at 1-800-456-2255 or via web at MSActiveSource.com.

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11th MS Disease-Modifying Drug Approved in the US

Also Tell Your Doctor About Minor MS Relapses

For an attack to be considered an MS relapse, it must meet the following criteria:

• New symptoms appear or old symptoms of MS become worse
• The episode of new or worsening symptoms lasts for more than 24 hours
• Symptoms of the relapse do not occur within 30 days of a previous relapse
• There is no other explanation for the symptoms

Treatment for relapses typically involves a course of high-dose intravenous steroids to reduce inflammation in the central nervous system and help speed relief of relapse-related symptoms. Some neurologists may have differing opinions as to when to treat a relapse, so patients may feel there is no reason to call the doctor’s office if the symptoms are relatively mild and do not significantly interfere with normal activities. Or, patients may feel they won’t be taken seriously by the doctor, so they don’t bother to call.

However, every relapse is an important event to acknowledge and report.  Even if a patient does not need or want steroids, it is recommended that their fluctuating symptoms be documented in their medical record.  Often, treatment decisions are made by examining your past medical history, including the number, frequency, and severity of relapses the patient has had.  Although no disease-modifying therapy (DMT) has been shown to be 100 percent effective in preventing relapses, experiencing too many relapses (even small ones) may indicate that the patient’s DMT is not working as well as it should.

Read this post in its entirety:

When to Report MS Relapses to Your Doctor

Disease-Modifying Therapies (DMTs) Help to Slow Down MS

To alter the course of the disease, a number of disease-modifying therapies (DMTs) are available which are designed to help slow down the long-term progression of MS.  These treatments, or disease-modifying agents, have been shown in clinical trials to be effective in decreasing the frequency of relapses and the number of lesions in the brain or spinal cord.  Some of these medications have also been shown to slow down the rate at which a person with MS accumulates disability.  Using DMTs is one way to fight back against MS.

Read this post in its entirety:

Slowing Down the Long-Term Progression of MS by Using Disease-Modifying Therapies (DMTs)

Treatment Decisions: Is Your MS Stable?

New research suggests that it may be safe to stop taking disease-modifying medication if your MS has been stable for an extended period of time.  In a recent study published in the the journal Arq Neuropsiquiatr, researchers in Brazil followed a group of 40 patients with relapsing-remitting MS for whom their disease had been clinically and radiologically stable for more than five years and who voluntarily chose to stop using disease-modifying therapy.

Patients included in the study had continuously used one of the following immunomodulatory disease-modifying drugs - Avonex, Betaseron, Rebif, Copaxone - for more than 5 years and up to 14 years.  To be included in the study, participants had to be disease-free for at least 5 years while on therapy.  Disease-free activity was defined as no clinical relapse, no sustained increase in disability as measured by EDSS (expanded disability status scale) score, and no new gadolinium-enhancing or active lesions as seen on MRI scans.

Read this post in its entirety:
MS and Medication Decisions: Can I stop taking my disease-modifying drug and still be okay?

RA Treatment: Triple Therapy

Rheumatologists will often begin their newly diagnosed patients on conventional DMARDs such as methotrexate (MTX), sulfasalazine (SSZ), hydroxychloroquine (HCQ), each alone or in any combination.  In fact, when combining the three drugs, it is commonly known as “triple therapy” and is often used as a step-up in treatment after trying MTX alone.

Triple therapy as a treatment approach to RA has received recent attention in the news due to a study published in the New England Journal of Medicine (NEJM) on June 11, 2013.  In this study, no significant difference in disease activity was demonstrated in patients who received triple therapy as compared to those who received treatment with etanercept + methotrexate. All the patients prior to enrolling in this study had experienced active disease despite methotrexate therapy alone (O’Dell, 2013).

In a similar study, the Treatment of Early Aggressive Rheumatoid Arthritis (TEAR) study, patients were randomly assigned to MTX monotherapy (alone), triple therapy, or MTX + etanercept with no significant difference in primary outcome (based on Disease Activity Severity DAS28 scores) between the latter two groups. However, x-rays did show more disease progression in the triple therapy group.

Read this post in its entirety:
What is the Role of Triple Therapy in RA?

Autoinjection Pens for MS

Since the approval of the first disease-modifying drug in 1993, the delivery method of the injectable medications for MS has improved with the development of pre-filled syringes and auto-injection devices.  Initially medications required mixing before they were ready to be injected.  Avonex, Betaseron, and Extavia are available in powered form requiring reconstitution.

The pre-filled syringe was designed to eliminate the need for mixing medication and for easy of use.  Avonex, Copaxone, and Rebif are available in pre-filled syringes.  To assist patients who may have difficulty reaching certain areas of the body for injection, or who have limited dexterity, or who may have a needle-phobia, auto-injection devices are available for use with syringes.  Manufacturers of Betaseron, Copaxone, and Rebif provide auto-injection devices for use with their medication which are designed to be reused and loaded with new syringes for each injection.

A new trend in self-injection technique and methodology is the single-use (disposable), pre-filled autoinjector or pen which comes preassembled, loaded with medication, and ready to use.  The Avonex® Pen™ was approved in February 2012 and just last week the FDA approved the Rebif® Rebidose® pen.  With both the Avonex and Rebif pens, the needle remains covered both before and after injection.  The Avonex® Pen™ is the first intramuscular (IM) autoinjector device approved for MS which incorporates a smaller needle and helps to reduce anxiety about self-injections.

Read this post in its entirety:

Disease-Modifying Drugs for MS: New Single-Use, Auto-Injection Device Approved

Do you think you should change treatments?

As soon as you were diagnosed with multiple sclerosis, you had many decisions to make. One of those was whether to use a disease-modifying drug and, subsequently, which one to use. You did your research, talked to friends and family, read online forums, and worked with your neurologist to choose an appropriate treatment plan which was right for you.

That treatment plan may have included a disease-modifying drug. What was the purpose of that drug? To slow the progression of the disease, to reduce lesions, and to limit the number of relapses you might have. Together, successful achievement of these goals hopefully prevent you from accumulating physical disability while you are on this MS journey.

But how do you know if the medication is working? MS is such an unpredictable disease with many natural ups and downs that it can be difficult to know if the medication is making a difference.


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When to Consider Changing Treatments