Injections

All DMDs need to be injected. The reason for this is that they are proteins, and as such they would be broken down in the stomach if they were taken orally. This has practical implications for you and your lifestyle. Some of the things which you could think about are:

• How will the injection pattern fit into your lifestyle - work, holidays and leisure activities?
  
• Are you physically and emotionally able to inject yourself?
  
• Can you deal with the practicalities of managing injections? Such as:
  
• Having a secure storage area for your syringes, needles and a special (sharps) box for discarded needles
  
• Space in your fridge or cupboards to store the medication at the correct temperature
  
• Keeping your medicines private, or explaining to others around you the fact that you are on the drugs

Autoinjectors

All of the DMDs come with the option of an automatic injecting device (an autoinjector). You can see how these work in the 'See the process' page. Some people find that autoinjectors make injecting easier - particularly in hard to reach places. With most types of autoinjector, it also means that you don't need to see the needle going in, which can be a help if you are not keen on needles.

Preparation and storage

Three of the DMDs (Avonex®, Rebif® and Copaxone®) come in a premixed form - this means that there is no need to mix the drug together before injecting it. Betaferon®, Extavia® and the BIO-SET version of Avonex® all have to be mixed before injection, which adds a minute or two to the time you need, but this does avoid the need for them to be stored in a fridge.

Injection methods

Four of the DMDs are injected under the skin (sub-cutaneous), and one (Avonex®) is injected into the muscle (intramuscular). Subcutaneous injections use a shorter and thinner needle. However, sub-cutaneous injections do lead to more skin-site reactions (as explained in the earlier Side-Effects section).

 

There is a lot of help and support available while you are on treatment, but these factors still need to be carefully considered.

If, like many people, you are concerned about injecting yourself, you might want to pay particular attention to Moira and Carol when you come to the "Listen to Others" section, who talk about what it's really like to inject yourself and how they managed to overcome their early fears and phobias.

This table gives you a chance to compare all the DMDs at a glance:

	Injection frequency	Where injected	Pre-mixed syringe available?	Storage
Interferon beta 1a: Avonex®	Once a week	Into the muscle	Two versions are available: a premixed version (PFS) which comes ready to inject, and a version which must be mixed before use (BIO- SET).	Premixed version: Fridge 2-8 °C, but a single vial can be kept at room temperature for up to a week. The BIO-SET version can be kept at room temperature for up to 2 years.
Interferon beta 1a: Rebif®	3 times a week	Under the skin	Three premixed versions are available: Prefilled syringes (for manual injection or use with the Rebiject II device), Multidose cartridges (for use with the RebiSmart autoinjector device) and the RebiDose prefilled pen.	All versions: In a fridge at 2-8°C. If they cannot be stored in a fridge, they can be stored at room temperature (below 25°C), once for up to 14 days.
Interferon beta 1b: Betaferon®	Alternate days	Under the skin	No	At room temperature up to 2 years.
Interferon beta 1b: Extavia®	Alternate days	Under the skin	No	At room temperature up to 2 years.
Glatiramer acetate: Copaxone®	Every day	Under the skin	Yes	In a fridge, at 2-8 °C. If they cannot be stored in a fridge, they can be stored at room temperature (15°C to 25°C), once for up to one month.