Rebif is known as a disease-modifying therapy for multiple sclerosis. Let me say upfront: This article is not about why disease-modifying therapy is a good idea, rather I have tried to put together as many facts as I could about Rebif in plain language. Why? When I was trying to choose my treatment, I know that it was hard to find information about these drugs that was from a neutral source. I watched the videos (with numerous smiling people gleefully giving themselves injections) from each company and would think, “that’s the one for me” – until I watched the next video.
Having set my goal as giving you the information that I was interested in when I was trying to make a decision about which MS treatment to start, I will start with my “Bottom Line,” summarizing my take on Rebif.
Bottom Line: With small variations, the treatment's effectiveness 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 about MS treatment based on their doctor’s advice and experience with similar patients. Other factors come into play for each patient, such as convenience, injection considerations, side effects and cost.
Rebif is basically the same formulation as Avonex (also Interferon beta-1a), but at a higher dose. Rebif has been shown to be slightly more effective than Avonex at preventing relapses. However, it is given three times a week (as opposed to Avonex’s once-a-week dosing), and people experience more injection site reactions (85% compared to 33% Avonex), more liver disorders (18% vs. 10% Avonex) and white blood cell disorders (13.6% vs. 5.3% Avonex). However, people experience fewer flu-like symptoms over time than Avonex (45% vs. 53% Avonex), and they seem to last for a shorter period after dosing.
Patients like the fact that Rebif needles are the tiniest of all and injections are subcutaneous (injected into the fat right under the skin), meaning the needle is easily inserted. However, injections can be more painful than others, due to lower pH of Rebif (which makes it acidic). Rebif is the most convenient of all to travel with, as it can be unrefrigerated, and requires no mixing (it comes in prefilled syringes). Rebif is the most expensive of all of the CRAB drugs. Like all of the interferons, patients on Rebif need to have bloodwork done regularly and be monitored closely for depression.
More Detailed Information on Rebif
Type of MS and Severity: Rebif is for people with RRMS.
Efficacy: Similar to all the CRAB drugs - decreased relapses by 33% in initial trial of patients with mild to moderate RRMS.
Necessary Monitoring: Blood tests need to be done every three months to check white blood cell count and liver function for the first year. After a year, they can be reduced to once every four months. People with known thyroid problems should be monitored every six months for thyroid dysfunction.
Injection Considerations: Rebif is given three times a week (12 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 – 1.25 inches), and is 29-gauge (which is the thinnest needle available for any MS therapies). However, Rebif is acidic (pH 3.8), which means injections often sting.
Side Effects: The side effects of Rebif are similar to those of the 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 69% of patients. These include: fever, chills, sweating, muscle aches and fatigue (but not nausea or stomach upset), and they last for 8 or more 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: Red spots usually occur at the site of injections (in 71% of patients), which may last several weeks. These can break down into sores (injection-site necrosis) in 5% of all 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. If you notice that you begin bruising easily or that your skin or the whites of your eyes begins to look yellow, go see your doctor immediately.
- Blood Counts: Rebif 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: Rebif should be used with caution in patients with depression.
- Allergic Reactions: Although rare, some people have experienced an allergic reaction to Rebif (which can happen after the first dose or after several doses), which has caused difficulty breathing and loss of consciousness.
- Thyroid Abnormalities: Rebif should be used with caution in people with thyroid dysfunction, who should be monitored for thyroid function every six months while on Rebif.