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Is Betaseron Right for You?

Betaseron and Multiple Sclerosis

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Updated July 21, 2009

Betaseron is known as a disease-modifying therapy for multiple sclerosis. I am not going to discuss why you should be on disease-modifying therapy in this article, rather give some points about Betaseron to help you decide if it is right choice for you from among existing disease-modifying therapies (DMT). My goal is to give you the practical information that I was interested in when I was trying to make a decision about which MS treatment to start. I will start with summarizing my take on Betaseron. I have then compiled more detailed information, which follows.

Bottom Line: Efficacy is about the same for all of the CRAB (Copaxone, Rebif, Avonex, Betaseron) drugs -- about one-third reduction in relapses when compared to a placebo over two years in people with relapsing-remitting MS (RRMS). People with RRMS usually make their decisions based on their doctor's advice and experience with similar patients, as well as concerns about convenience, side effects and cost.

Betaseron (Interferon beta-1b) has been on the market longer than any other disease-modifying therapy. It provides the highest weekly dose of all interferons, at 250mcg/dose, given every other day. It is a subcutaneous (meaning that it is injected into the fat right under the skin) formula and is neutral pH, as opposed to Avonex (intramuscular, meaning injected into muscle) and Rebif (also subcutaneous, but acidic, so injections can be painful). Most patients develop red spots at injection sites, which, in rare cases, can develop into sores.

Betaseron comes with the usual interferon-related, flu-like symptoms, especially at the beginning of treatment. Since it is given every other day, this makes it difficult for people who work full-time or otherwise need to be "on the go" constantly, as opposed to Avonex (once a week dosing) or Copaxone (non-interferon, so no flu-like side effects). However, Betaseron comes with a titration schedule (meaning patients start at a small dose and increase gradually), which is claimed to greatly reduce these side effects. Betaseron requires mixing (as opposed to the others, which come in pre-filled syringes), but this allows it to be kept at room temperature (handy for travel and doesn't require a wait while it comes to room temperature). It does require that patients get blood drawn regularly to monitor liver function and white blood cell count.

More Detailed Information on Betaseron

Type of MS and Severity: Betaseron is for people with RRMS and progressive-relapsing MS (PRMS). It is also approved for use in people who have experienced one MS event, but do not yet meet all criteria for MS.

Efficacy: As mentioned, efficacy is about the same for all of the CRAB drugs -- about one-third reduction in relapses when compared to a placebo over two years. Studies show that there is evidence that the higher-dose interferons (Betaseron and Rebif) may be slightly more effective at preventing relapses and reducing lesions than the lower dose (Avonex). Studies have shown that long-term treatment with Betaseron at the first event may reduce the risk of a second MS attack by 50%. In other words, if a person has an MRI scan with lesions and/or symptoms of a relapse, if they take Betaseron, it may lower their risk of developing clinically definite MS by 60%. If untreated, 85% of people experiencing one event will develop MS within 2 years.

Necessary Monitoring: Blood tests need to be done every three months for the first year to check white blood cell count and liver function. After a year, they can be reduced to once every four months.

Injection Considerations: Betaseron is given every other day (14 times a month) as a subcutaneous (under the skin) injection, usually done by the patient themselves or a family member. The needle is shorter than for intramuscular therapies (.5 inch versus 1 to 1.25 inches), and is 27 gauge, which is pretty thin. A Betaject 3 automatic injecting device is provided.

Side Effects: The side effects of Betaseron are similar to those of other interferon-based therapies with the exception of Avonex, which doesn't cause as many injection-site reactions.

  • Flu-like Symptoms: The most important side effect is the flu-like symptoms, which are experienced by about 76% of patients. These include fever, chills, sweating, muscle aches and fatigue, which last for 24 to 36 hours. This side effect is usually the worst after the first injection and progressively lessens with each injection, so that most people do experience it or it is tolerable after six months. It can also be reduced by starting with a low dose and increasing to a full dose gradually, over several weeks. Taking ibuprofen or acetaminophen a couple hours before and after can help with some of these side effects.
  • Red spots: These usually occur at the site of injections (in 85% of patients), which may last several weeks. These can break down into sores (injection-site necrosis) in 4% of cases.
  • Liver Damage: Hepatic injury including elevated serum hepatic enzyme levels and hepatitis has been reported. Regular monitoring is required to prevent such damage from occurring or progressing.
  • Blood Counts: Betaseron can cause a decrease in the numbers of red and white blood cells, as well as a reduction in the number of platelets in the blood.
  • Depression: Betaseron should be used with caution in patients with depression.
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