Adherence to interferon ß-1a therapy using an electronic self-injector in multiple sclerosis: a multicentre, single-arm, observational, phase IV study.

BACKGROUND: In a multicentre, single-arm, observational, phase IV study, we evaluated 24-week treatment adherence of relapsing multiple sclerosis (RMS) patients using an electronic auto-injection device (RebiSmart(®)) for subcutaneous injection of interferon (IFN) ß-1a. METHODS: A total of 162 adult participants with RMS were enrolled into the study to use RebiSmart(®) to self-administer IFN ß-1a 44 µg three times weekly for a maximum of 96 weeks. The number of administered injections was recorded in the electronic device log. Adherence to treatment was defined as the administration of ≥80% of expected injections. Cognitive impairment and injection anxiety were assessed via questionnaires. RESULTS: Overall, 91.8 and 82.9% of participants were adherent to treatment at weeks 12 and 24, respectively. By weeks 12 and 24, 8.2 and 13.9% of participants had discontinued treatment. There were no statistically significant differences in adherence rates at weeks 12 and 24 according to cognitive impairment status or injection anxiety. By week 24, 69.9% of participants were less fearful of injection than when they started the study. According to participant evaluations, the absence of a visible needle, comfort settings, and the calendar for tracking the injection schedule were all important features of the RebiSmart(®) injection system. At week 24, 99.3% of participants reported that they would like to continue using RebiSmart(®) as their injector. CONCLUSIONS: RebiSmart(®) use is associated with high treatment adherence, as objectively assessed using electronic injection logs. Future research should examine if RebiSmart(®) use improves long-term treatment outcomes in RMS. This study was registered with ClinicalTrials.gov as NCT01128075, on May 20, 2010.

Review of subcutaneous interferon ß-1a, delivered via the electronic self-injection device RebiSmart™, for the treatment of multiple sclerosis.

Multiple sclerosis is a chronic disease requiring lifelong treatment with disease-modifying drugs that aim to prevent relapses and slow the progression of disability. The established first-line treatments for multiple sclerosis all require regular injections, and real-world observations suggest that long-term adherence to treatment is low. Indeed, poor adherence to disease-modifying drug treatment has been associated with poorer clinical outcomes. Autoinjectors have been developed to improve the success of self-injection, whilst also making injections more comfortable for patients, with the aim of minimizing obstacles to treatment adherence. RebiSmart™ is a new electronic autoinjector for subcutaneous administration of interferon ß-1a (Rebif®) that includes several unique features designed to further reduce barriers to adherence, including a dosing log and adjustable comfort settings.

Does the season or month of birth influence disease progression in multiple sclerosis?

We investigated the influence of season and birth month on sustained progression to Expanded Disability Status Scale 6 (requires a cane) through a database review of 2,319 definite multiple sclerosis (MS) patients followed for a mean 19.3 years, until July 2003 in British Columbia, Canada. The season of birth had a marginal effect on disease progression (p = 0.051), with winter babies exhibiting the slowest progression (p = 0.048). Birth month had a significant effect on progression (p = 0.038), mainly due to those January born having a 40% (95% CI 32.9-47.4) chance of requiring a cane later than those born in other months. There was some evidence to suggest that the gestational period had a small but long-lasting effect on later disease progression in British Columbia, Canada.

Remission of multiple sclerosis post-liver transplantation.

BACKGROUND: The effect of liver transplantation on pre-existing multiple sclerosis (MS) has never been reported. We report the three year post-transplant neurological outcome of a patient with MS. CASE REPORT: A Caucasian woman with MS received an urgent liver transplant for fulminant liver failure at the age of 59. Her Extended Disability Scale Score (EDSS) pretransplant was 5.0 and clinically she had cerebellar and brainstem dysfunction. Post-transplant immunosuppression consisted of tacrolimus, mycophenolate mofetil and tapering corticosteroids that were discontinued after 1.5 years. Post-transplant her EDSS decreased to 2.0 and after three years she is clinically asymptomatic with only very mild dysarthria on neurologic examination. Long-term maintenance immunosuppression consists of low dose tacrolimus. CONCLUSIONS: Combination immunosuppression with tacrolimus may have a beneficial effect on MS although an effect of donor allograft itself can not be excluded.