Multiple Sclerosis - Medications

glatiramer (Copaxone® )	interferon beta-1A (Avonex ® , Rebif ® )
interferon beta-1B (Betaseron ®)

glatiramer (Copaxone® )

Mechanism of Action
The mechanism(s) by which glatiramer acetate exerts its effects in patients with Multiple Sclerosis (MS) is (are) not fully elucidated. However, it is thought to act by modifying immune processes that are currently believed to be responsible for the pathogenesis of MS. This hypothesis is supported by findings of studies that have been carried out to explore the pathogenesis of experimental allergic encephalomyelitis (EAE), a condition induced in several animal species through immunization against central nervous system derived material containing myelin and often used as an experimental animal model of MS. Studies in animals and in vitro systems suggest that upon its administration, glatiramer acetate-specific suppressor T-cells are induced and activated in the periphery.

Because glatiramer acetate can modify immune functions, concerns exist about its potential to alter naturally occurring immune responses. Results of a limited battery of tests designed to evaluate this risk produced no finding of concern; nevertheless, there is no logical way to absolutely exclude this possibility.

INDICATIONS AND USAGE
COPAXONE® Injection is indicated for reduction of the frequency of relapses in patients with Relapsing-Remitting Multiple Sclerosis.

CONTRAINDICATIONS
COPAXONE® Injection is contraindicated in patients with known hypersensitivity to glatiramer acetate or mannitol.

WARNINGS
The only recommended route of administration of COPAXONE® Injection is the subcutaneous route. COPAXONE® Injection should not be administered by the intravenous route

Dosing (Adults): (usual)
SubQ: 20 mg daily

Administration
For SubQ administration in the arms, abdomen, hips or thighs. Bring to room temperature prior to use.

SUPPLIED:
Injection, solution [preservative free]: 20 mg/mL (1 mL) [prefilled syringe; contains mannitol; packaged with alcohol pads]

interferon beta-1A (Avonex ® , Rebif ® )

DOSING (Adults): Note: Analgesics and/or antipyretics may help decrease flu-like symptoms on treatment days:
I.M. (Avonex®): 30 mcg once weekly

SubQ (Rebif®): Doses should be separated by at least 48 hours:
Target dose 44 mcg 3 times/week:
Initial: 8.8 mcg (20 % of final dose) 3 times/week for 8 weeks
Titration: 22 mcg (50% of final dose) 3 times/week for 8 weeks
Final dose: 44 mcg 3 times/week

Target dose 22 mcg 3 times/week:
Initial: 4.4 mcg (20 % of final dose) 3 times/week for 8 weeks
Titration: 11 mcg (50% of final dose) 3 times/week for 8 weeks
Final dose: 22 mcg 3 times/week

Dosage adjustment in hepatic impairment: Rebif®: If liver function tests increase or in case of leukopenia: Decrease dose 20% to 50% until toxicity resolves

Administration
Avonex®: Must be administered by I.M. injection

Rebif®: Administer SubQ at the same time of day on the same 3 days each week (ie, late afternoon/evening Mon, Wed, Fri); rotate injection site

SUPPLIED:
Combination package [preservative free] (Rebif® Titration Pack):
Injection, solution: 8.8 mcg/0.2 mL (0.2 mL) [6 prefilled syringes; contains albumin]
Injection, solution: 22 mcg/0.5 mL (0.5 mL) [6 prefilled syringes; contains albumin]

Injection, powder for reconstitution (Avonex®): 33 mcg [6.6 million units; provides 30 mcg/mL following reconstitution] [contains albumin; packaged with SWFI, alcohol wipes, and access pin and needle]

Injection, solution (Avonex®): 30 mcg/0.5 mL (0.5 mL) [albumin free; prefilled syringe; syringe cap contains latex; packaged with alcohol wipes, gauze pad, and adhesive bandages]

Injection, solution [preservative free] (Rebif®): 22 mcg/0.5 mL (0.5 mL) [prefilled syringe; contains albumin]; 44 mcg/0.5 mL (0.5 mL) [prefilled syringe; contains albumin]

interferon beta-1B (Betaseron ®)

DOSING (Adults):
SubQ:
Children <18 years: Not recommended
Adults: 0.25 mg (8 million units) every other day

Administration
Withdraw 1 mL of reconstituted solution from the vial into a sterile syringe fitted with a 27-gauge needle and inject the solution subcutaneously; sites for self-injection include arms, abdomen, hips, and thighs

SUPPLIED:
Injection, powder for reconstitution [preservative free]: 0.3 mg [9.6 million units]
Recommended dose: 0.25 mg injected subcutaneously every other day.

Disclaimer

Listed dosages are for - Adult patients ONLY. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon.

David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.