Multiple sclerosis, also known as disseminated sclerosis is an autoimmune disease in which the patient's immune system is hyperactive and attacks cells and nerve fibers, leading finally to demyelination. The condition is debilitating and chronic evolution character. Due to destruction of myelin protective sheath is affected the communication between the brain and the rest of the nervous structures and this finally reach to the destruction of nerve itself, not just its sheath.
Symptoms of the disease vary greatly from patient to patient, depending mainly on the number of fibers involved in the destructive process. Sclerosis patients have severe speech disorders, gait, balance, and many eye symptoms (diplopia, decreased visual acuity).
Multiple Sclerosis can occur at any age, but most often patients are diagnosed between 20 and 40 years. Like most autoimmune diseases it is more common in women than men. Multiple Sclerosis has no cure yet, but is a treatment that can significantly improve symptoms and can interfere with immune aggression on nerve cells.
Currently Multiple Sclerosis treatment include:
1. Corticosteroids can reduce inflammation that causes nerve damage;
2. Administration of interferon who allegedly can reduce the rate of progression and worsening of symptoms over time;
3. Disease-modifying drugs such as natalizumab.
These drugs differ greatly among themselves in terms of efficacy and systemic toxicity. In addition, not all patients respond to these drugs. It is already known that about 30% of those diagnosed with Multiple Sclerosis are non-responsive to interferon treatment. Initial indications of treatment depend on the clinical form of the disease. If the patient has mild form, often doctors prefer to use a simple treatment and the patient must be observed closely. If instead, the evolution is marked by many episodes of overheating, treatment need to be installed as soon as possible and the combination chosen must ensure maximum efficiency. Recently, beta interferon in Multiple Sclerosis treatment is scientifically proven to be an important ally in the fight against relapsing and in regulating the immune response of the body.
Mechanism of action
Interferon beta in Multiple Sclerosis treatment looks very much with interferon product by the body as a natural response to infection and to other offenses that trigger immune reactions. Mechanism of action of interferon beta in Multiple Sclerosis treatment is poorly understood, but it is known that interferon generally has immunomodulatory and antiviral activities, and in this situation can prevent sharp demyelination of nerve fibers. Also, interferon beta can significantly reduce the action of interferon gamma, a protein with an important pathogenic role in Multiple Sclerosis. Currently there are several types of interferon beta:
-beta 1a: can be injected either weekly or three times a week;
-beta 1b: which is injected once, every two days.
Interferon beta 1a is produced by mammalian cells, while interferon beta 1b is produced by a modified bacterium. Although the mechanism is not completely understood, experts agree that interferon act beneficial by reducing immune reactions. Interferon can improve integrity and functionality of the blood-brain barrier that in Multiple Sclerosis patients is quite altered and some of the toxic substances from the body can readily penetrate the brain.
Indications management
Interferon in Multiple Sclerosis treatment is recommended for patients with a worse form, which is characterized by multiple attacks and exacerbation followed by periods of calm clinic. Interferon is highly recommended in patients with secondary progressive form of Multiple Sclerosis, a form of the disease symptoms are almost constant and do not seem to improve over time. Moreover, the disease is aggravated unfavorable.
Interferon beta, both in form 1a and 1b may be a therapeutic option with other forms of Multiple Sclerosis, such as:
1. Isolated clinical form of Multiple Sclerosis, which can only manifest as optic neuritis, but has radiogist signs(especially MRI) of chronic disease. Such patients, although initially are asymptomatic, come to develop complex forms of disease and treatment is indicated since the diagnosis of neuritis, because they can interfere with evolution, improving patient prognosis and subsequent symptoms;
2. Juvenile form. Even if it is considered a safe treatment for patients aged over 18 years, also interferon beta was successfully administered in children. Interferon can reduce up to 40% frequency of attacks and rebound and can slow the disease but can not cure Multiple Sclerosis.
Recent studies have demonstrated the following:
- Interferon administered immediately after diagnosis of certainty may influence disease severity and reduce by one third the frequency of disease flares;
- Patients being treated with interferon have fewer brain areas affected by multiple sclerosis, which confirms the making of MRI;
- Treatment with interferon can significantly reduce the risk of disabilities that affect independent patient;
- Interferon can stop or slow the patient's impaired cognitive function;
- Interferon beta-1 can be integrated regimens since the emergence of the first attack of multiple sclerosis, even if the disease itself may still be diagnosed radioimagistic.
Side effects of Interferon in Multiple Sclerosis treatment
The most commonly reported side effects of interferon include:
- Flu-like symptoms such as fatigue, fever, chills, myalgia, arthralgia. They occur 1-2 days after injection, but not continuous throughout the therapy. Generally disappear after 2 or 3 months of continuous treatment. Some of the patients they feel stronger and you can even interfere significantly with quality of life and ability to perform daily chores. Severity of symptoms may be reduced by administering a painkiller such as ibuprofen before each injection;
- Headache;
- Swelling, redness and pain at the injection site;
- Depression. This is a side effect that contraindicate intramuscular interferon compounds in patients with existing depression with mood disorders and suicidal thoughts or attempts;
- Anxiety, confusion, changes in appetite and sleep disturbances. These side effects are very common and can occur both due to treatment, and because the disease itself. If these symptoms last longer than two days, patients are advised to consult a doctor to investigate the situation and perhaps to change treatment.
Patients in chronic treatment with interferon should be carefully monitored during therapy. General checks are recommended every 3 months to check blood counts and liver function as interferon can affect liver toxic over time.
Special warnings
Depression is a big problem in patients with chronic Multiple Sclerosis under treatment with interferon. It is so because the disease itself as well as to management following therapy. Therefore patients are advised to discuss with your doctor any changes in mood and mental tone, but you must announce before starting therapy if they have a positive history of psychiatric disorders, or if they are in treatment for depression, bipolar disorder .
In general, treatment with interferon should not be initiated until after the doctor is sure that accurate diagnosis is multiple sclerosis. Therapy is recommended to prevent disease progression and to protect the nervous system. There are patients who recover after the attacks of multiple sclerosis even in the absence of treatment, but most go through very bad phase, significantly affecting their life and can have unpleasant and unwanted consequences in the future. Sometimes, even if symptoms are minimal, the disease progresses and the onset is sudden, brutal, and the weather can be overcome in terms of treatment. In patients with risk factors, experts consider treatment administration indicated after the first attack of the disease, even if the lesion does not seem to be extended.
Risk factors considered are:
1. Age and sex: patients between 20 and 40 years, especially women can have an unfavorable outcome if treatment is not instituted;
2. Concurrent or history: particularly with Epstein Barr virus, the etiologic agent of infectious mononucleosis;
3. Chronic diseases: irritable bowel syndrome, type 1 diabetes, thyroid pathology, and other autoimmune diseases.
Side effects of interferon therapy can be very important and often affects the patient's life. They can be reduced by concomitant administration of analgesics and gloves (to combat flu-like syndrome) that may increase drug tolerance, and can allow the doctor to increase the dose. This is very important for patients who are in chronic treatment with interferon.
Besides the side effects of the drug itself, interferon has some disadvantages:
- Treatment is not effective in 100% of cases and is difficult to assess whether a particular patient will go or not, because we do not know exactly which is why people appear non-responsive;
- Risks of long-term treatment are not yet known because interferon is not integrated for very long regimens;
- Some experts fear that while interferon efficiency will decrease because the body is able to secrete neutralizing antibodies that reduce its action;
- Costs are very high in interferon therapy.
If after 6 months of therapy with interferon symptoms have not showed any improvement and attacks are as common, patients are advised to consult with their doctor because there is the possibility that treatment need to be changed. Therapy with interferon administration should be done only if the benefits outweigh the risks, and the possibility of developing resistance to treatment is reduced.
Interferon is not a safe drug to be administered during pregnancy. Some studies have shown that it associates a significant risk of miscarriage. Therefore, experts insist that women treated with this compound must use a contraceptive method, if it is any possibility of getting pregnant. If the woman becomes pregnant during treatment, the women is advised to call her doctor and for now long the evolution of pregnancy must be kept under control and followed by physiological and pathological peculiarities of the individual woman.
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Symptoms of the disease vary greatly from patient to patient, depending mainly on the number of fibers involved in the destructive process. Sclerosis patients have severe speech disorders, gait, balance, and many eye symptoms (diplopia, decreased visual acuity).
Multiple Sclerosis can occur at any age, but most often patients are diagnosed between 20 and 40 years. Like most autoimmune diseases it is more common in women than men. Multiple Sclerosis has no cure yet, but is a treatment that can significantly improve symptoms and can interfere with immune aggression on nerve cells.
Currently Multiple Sclerosis treatment include:
1. Corticosteroids can reduce inflammation that causes nerve damage;
2. Administration of interferon who allegedly can reduce the rate of progression and worsening of symptoms over time;
3. Disease-modifying drugs such as natalizumab.
These drugs differ greatly among themselves in terms of efficacy and systemic toxicity. In addition, not all patients respond to these drugs. It is already known that about 30% of those diagnosed with Multiple Sclerosis are non-responsive to interferon treatment. Initial indications of treatment depend on the clinical form of the disease. If the patient has mild form, often doctors prefer to use a simple treatment and the patient must be observed closely. If instead, the evolution is marked by many episodes of overheating, treatment need to be installed as soon as possible and the combination chosen must ensure maximum efficiency. Recently, beta interferon in Multiple Sclerosis treatment is scientifically proven to be an important ally in the fight against relapsing and in regulating the immune response of the body.
Mechanism of action
Interferon beta in Multiple Sclerosis treatment looks very much with interferon product by the body as a natural response to infection and to other offenses that trigger immune reactions. Mechanism of action of interferon beta in Multiple Sclerosis treatment is poorly understood, but it is known that interferon generally has immunomodulatory and antiviral activities, and in this situation can prevent sharp demyelination of nerve fibers. Also, interferon beta can significantly reduce the action of interferon gamma, a protein with an important pathogenic role in Multiple Sclerosis. Currently there are several types of interferon beta:
-beta 1a: can be injected either weekly or three times a week;
-beta 1b: which is injected once, every two days.
Interferon beta 1a is produced by mammalian cells, while interferon beta 1b is produced by a modified bacterium. Although the mechanism is not completely understood, experts agree that interferon act beneficial by reducing immune reactions. Interferon can improve integrity and functionality of the blood-brain barrier that in Multiple Sclerosis patients is quite altered and some of the toxic substances from the body can readily penetrate the brain.
Indications management
Interferon in Multiple Sclerosis treatment is recommended for patients with a worse form, which is characterized by multiple attacks and exacerbation followed by periods of calm clinic. Interferon is highly recommended in patients with secondary progressive form of Multiple Sclerosis, a form of the disease symptoms are almost constant and do not seem to improve over time. Moreover, the disease is aggravated unfavorable.
Interferon beta, both in form 1a and 1b may be a therapeutic option with other forms of Multiple Sclerosis, such as:
1. Isolated clinical form of Multiple Sclerosis, which can only manifest as optic neuritis, but has radiogist signs(especially MRI) of chronic disease. Such patients, although initially are asymptomatic, come to develop complex forms of disease and treatment is indicated since the diagnosis of neuritis, because they can interfere with evolution, improving patient prognosis and subsequent symptoms;
2. Juvenile form. Even if it is considered a safe treatment for patients aged over 18 years, also interferon beta was successfully administered in children. Interferon can reduce up to 40% frequency of attacks and rebound and can slow the disease but can not cure Multiple Sclerosis.
Recent studies have demonstrated the following:
- Interferon administered immediately after diagnosis of certainty may influence disease severity and reduce by one third the frequency of disease flares;
- Patients being treated with interferon have fewer brain areas affected by multiple sclerosis, which confirms the making of MRI;
- Treatment with interferon can significantly reduce the risk of disabilities that affect independent patient;
- Interferon can stop or slow the patient's impaired cognitive function;
- Interferon beta-1 can be integrated regimens since the emergence of the first attack of multiple sclerosis, even if the disease itself may still be diagnosed radioimagistic.
Side effects of Interferon in Multiple Sclerosis treatment
The most commonly reported side effects of interferon include:
- Flu-like symptoms such as fatigue, fever, chills, myalgia, arthralgia. They occur 1-2 days after injection, but not continuous throughout the therapy. Generally disappear after 2 or 3 months of continuous treatment. Some of the patients they feel stronger and you can even interfere significantly with quality of life and ability to perform daily chores. Severity of symptoms may be reduced by administering a painkiller such as ibuprofen before each injection;
- Headache;
- Swelling, redness and pain at the injection site;
- Depression. This is a side effect that contraindicate intramuscular interferon compounds in patients with existing depression with mood disorders and suicidal thoughts or attempts;
- Anxiety, confusion, changes in appetite and sleep disturbances. These side effects are very common and can occur both due to treatment, and because the disease itself. If these symptoms last longer than two days, patients are advised to consult a doctor to investigate the situation and perhaps to change treatment.
Patients in chronic treatment with interferon should be carefully monitored during therapy. General checks are recommended every 3 months to check blood counts and liver function as interferon can affect liver toxic over time.
Special warnings
Depression is a big problem in patients with chronic Multiple Sclerosis under treatment with interferon. It is so because the disease itself as well as to management following therapy. Therefore patients are advised to discuss with your doctor any changes in mood and mental tone, but you must announce before starting therapy if they have a positive history of psychiatric disorders, or if they are in treatment for depression, bipolar disorder .
In general, treatment with interferon should not be initiated until after the doctor is sure that accurate diagnosis is multiple sclerosis. Therapy is recommended to prevent disease progression and to protect the nervous system. There are patients who recover after the attacks of multiple sclerosis even in the absence of treatment, but most go through very bad phase, significantly affecting their life and can have unpleasant and unwanted consequences in the future. Sometimes, even if symptoms are minimal, the disease progresses and the onset is sudden, brutal, and the weather can be overcome in terms of treatment. In patients with risk factors, experts consider treatment administration indicated after the first attack of the disease, even if the lesion does not seem to be extended.
Risk factors considered are:
1. Age and sex: patients between 20 and 40 years, especially women can have an unfavorable outcome if treatment is not instituted;
2. Concurrent or history: particularly with Epstein Barr virus, the etiologic agent of infectious mononucleosis;
3. Chronic diseases: irritable bowel syndrome, type 1 diabetes, thyroid pathology, and other autoimmune diseases.
Side effects of interferon therapy can be very important and often affects the patient's life. They can be reduced by concomitant administration of analgesics and gloves (to combat flu-like syndrome) that may increase drug tolerance, and can allow the doctor to increase the dose. This is very important for patients who are in chronic treatment with interferon.
Besides the side effects of the drug itself, interferon has some disadvantages:
- Treatment is not effective in 100% of cases and is difficult to assess whether a particular patient will go or not, because we do not know exactly which is why people appear non-responsive;
- Risks of long-term treatment are not yet known because interferon is not integrated for very long regimens;
- Some experts fear that while interferon efficiency will decrease because the body is able to secrete neutralizing antibodies that reduce its action;
- Costs are very high in interferon therapy.
If after 6 months of therapy with interferon symptoms have not showed any improvement and attacks are as common, patients are advised to consult with their doctor because there is the possibility that treatment need to be changed. Therapy with interferon administration should be done only if the benefits outweigh the risks, and the possibility of developing resistance to treatment is reduced.
Interferon is not a safe drug to be administered during pregnancy. Some studies have shown that it associates a significant risk of miscarriage. Therefore, experts insist that women treated with this compound must use a contraceptive method, if it is any possibility of getting pregnant. If the woman becomes pregnant during treatment, the women is advised to call her doctor and for now long the evolution of pregnancy must be kept under control and followed by physiological and pathological peculiarities of the individual woman.
