Issue 1: The drugs can have side effects
All medicines can potentially have side effects, or unwanted effects, and
DMDs for multiple sclerosis are no exception. Not all side effects occur with
all the drugs, and different people will experience side effects differently.
Some side effects are clearly felt by patients taking these drugs, others
may not be apparent at all.
The most common side effects with DMDs are as follows:
Flu-like side effects
Symptoms such as muscle aches, a mild fever and chills can occur in the first
48 hours after taking the drug. These can be reduced by taking the drug at night
so that you sleep through the side effects, or by taking a pain relieving drug
such as aspirin, ibuprofen or paracetamol with the injection and every 6-8 hours
afterwards, as you feel you need it. But remember that
non-steroidal
analgesics are not suitable for some people and must be taken with food.
These symptoms can occur with Avonex®, Rebif® and Betaferon®
They are quite common, affecting about 50% of patients at the early stage of
their treatment.
However, these symptoms usually pass within 3 to 6 months of starting treatment
and ease after the first few injections. They can be minimised by starting on
a lower dose and increasing it gradually - something which your specialist can
advise on.
Injection site problems
Skin Site Reactions
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A typical skin site reaction,
which fades over time
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Skin often reddens in the area
where you inject the DMD, although this fades in time. The site of the injection
may also become painful or quite hard and lumpy in places after a few months.
Very rarely (in about 1-2% of patients), the injection site can become dark
or discoloured and this needs to be reported to a doctor immediately as it
may indicate
necrosis.
This can occur with: Rebif®, Betaferon®, Copaxone®.
Mild reactions can occur in up to 50% of people who take these DMDs.
However, you can reduce the likelihood of injection site reactions by good injection
techniques. These include keeping the skin clean, regularly changing the injection
site and making sure that the drug is at room temperature before injecting.
Lipoatrophy
Some people experience a condition at injection sites called lipoatrophy. This
is a condition which can occur with many injected drugs and even with acupuncture
needles, where the fat beneath the skin is lost in small areas. This results
in small 'craters' or indentations in the skin, which can sometimes be disfiguring
and do not usually get better with time. It is not clear exactly why lipoatrophy
occurs, but it seems to be more common in women than in men.
This can occur with Copaxone ®.
Some degree of lipoatrophy has been reported to occur in a significant minority
of patients who take this DMD over a prolonged period (Edgar 2004, Mancardi
2000).
However, the long term effects can be minimised by inspecting injection sites
regularly, keeping them healthy and avoiding further injections in sites which
have been affected.
Changes in menstruation
Sometimes the drugs can cause irregular bleeding, early or late periods. If
this causes you concern, you should ask for a referral to a gynaecologist
This can occur with: Avonex®, Rebif®, Betaferon®
These symptoms are rare.
Blood screening abnormalities
Rarely, DMDs can cause such things as mild
anaemia,
liver abnormalities and reduction in white blood cell count. In most cases these
effects are very mild and only detected through a blood test.
This can occur with: Avonex®, Rebif®, Betaferon®
Liver abnormalities are relatively common in people who take these DMDs, affecting
about 50-70% of patients. However, they usually settle down on their own, and
only lead to the need to stop treatment in around 1 in 200 people (Francis 2003).
The World Health Organisation has come up with a grading system to categorise
blood abnormalities depending on how serious they are, and suggest what needs
to be done as a result. For more details use the link at the bottom of the page.
Mood changes
Depression is relatively common in people with multiple sclerosis, and there
has been some debate about whether beta interferons can make this worse. If
you have been prone to mood changes before starting to take these drugs, discuss
this with your MS nurse and/or neurologist.
Neurological symptoms
Some DMDs can cause a flare up of MS symptoms or an increase in spasticity which
following injection which dies down within 48 hours. In some cases, this may
because the drugs cause a mild fever, as many patients with MS find that their
symptoms increase in responses to a rise in their body temperature.
This can occur with: Avonex®, Rebif®, Betaferon®
It is rare, and usually lessens over time.
Post-Injection Reactions
Some people can experience a post-injection reaction which takes the form of
chest discomfort or a tightness in the chest, shortness of breath, anxiety,
flushing, sweating and palpitations immediately within a few hours of injecting.
These symptoms usually pass quickly (in 30 seconds or so), but in some cases
they can last for as long as 30 minutes. There is no consistency - they can
occur at any time and not just after the first injection.
This can occur with: Copaxone ®
Go to the supplementary page for more details about WHO
guidelines on blood monitoring.
