MS decisions - About Injections

Issue 2: The inconvenience and lifestyle impact of regular 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:

Have you got 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

If you have children or animals, the need to keep medicines secure is particularly important.

All of the DMDs come with the option of an automatic injecting device (an autoinjector). This looks a bit like a pen which you can take apart and put the needle and syringe inside. You then simply hold the device in the place where you want to inject, and press a button to deliver the drug. 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.

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. However, Betaferon® has to be mixed together before injection, which adds a few minutes to the time you need. There is also an alternative form of Avonex which does not need to be stored in a fridge, but which also has to be mixed up before use.

Three 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 under the Side-Effects section above).

There is a lot of help and support available while you are on this form of treatment, but these inconvenience 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.

Some people might feel that the inconvenience depends on how frequently the injections must be given and whether the drug needs to be kept in a fridge (which can be difficult if you tend to travel a lot).

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

	Injection frequency	Where injected	Pre-mixed syringe available?	Storage
Beta interferon 1a Avonex ®	Once a week	Into the muscle	Two versions are available. There is a premixed version which needs to be kept cold at all times. The non-premixed version can be stored at room temperature.	Fridge: 2-8 degrees C, or at room temperature for the version of the drug which must be mixed up before use.
Beta interferon 1b Betaferon ®	Alternate days	Under the skin	No	At room temperature up to 2 years
Glatiramer Acetate Copaxone ®	Every day	Under the skin	Yes	At room temperature, but only up to 7 days (otherwise fridge)
Beta interferon 1a Rebif ®	3 times a week	Under the skin	Yes	At room temperature, but only up to 30 days (otherwise fridge)

Factors to consider in your decision

Injections

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