Standard Dose Weekly Intramuscular Beta Interferon-1a May Be Inadequate for Some Patients with Multiple Sclerosis: A 19-Year Clinical Experience Using Twice a Week Dosage

Introduction Results from several clinical trials suggest there is a dose-response effect for beta interferon-1a (INF beta 1a) in multiple sclerosis (MS). Methods Our objective was to confirm these results through a retrospective analysis of patients with MS who had breakthrough disease (BD) on intramuscular (IM) INF beta 1a (Avonex (R)) once per week (QW), who were switched to twice per week (BIW) IM INF beta 1a between 1995 and 2015. The primary outcome measure was no further BD for at least 24 months. A secondary outcome measure was decrease in mean percentage of disease activity over time. BD was defined as continued relapses, new T2 or enhanced lesions on magnetic resonance imaging (MRI) of the brain, or worsening of the Expanded Disability Status Scale (EDSS) or the neurological examination. Results Among 92 patients on QW IM INF beta 1a, 53 patients with BD were switched to BIW IM INF beta 1a. Of these 53 patients, 44 had adequate follow-up for at least 2 years. Twenty-three of these had no further BD for 24 months or more (range 24-192 months). Beta interferon neutralizing antibody testing was negative in 19 patients. An intent-to-treat analysis of the uncensored data from 52 switched patients also supported a treatment benefit. Conclusion For patients with MS having breakthrough disease on QW INF beta 1a, switching to more frequently administered INF beta may be an option. Advantages to using IM INF beta 1a for this include no skin reactions and a lower incidence of neutralizing antibodies. Further pragmatic, observational, larger-group studies comparing treatment with Avonex (R) and higher dosed IM INF beta 1a, such as the recently FDA-approved IM peginterferon beta-1a, may be indicated.

Automated summary

The retrospective analysis confirmed that switching from once weekly to twice weekly administration of INF beta 1a may be an option for multiple sclerosis patients with breakthrough disease. Using IM INF beta 1a has advantages such as no skin reactions and a lower incidence of neutralizing antibodies.