Alleviating flu-like symptoms with dose titration and analgesics in MS patients on intramuscular interferon beta‑1a therapy: a pilot study

ABSTRACT

Objective: To determine the effectiveness of dose titration and choice of analgesic in reducing flu-like side effects of intramuscular interferon beta‑1a (IM IFNβ‑1a).

Methods: Patients were randomly assigned to receive weekly IM IFNβ‑1a, with or without dose titration, plus acetaminophen or ibuprofen. After 27 patients had been randomized, the original formulation of IM IFNβ‑1a became unavailable and the remaining patients used a pre-packaged liquid formulation, necessitating a change in protocol from initially quarter-dose to half-dose titration. Patients scored presence and intensity of muscle aches, chills, and weakness, and measured body temperature; information was recorded in diaries.

Results: Forty-seven patients were enrolled; 36 completed the study. Fifteen patients received full-dose therapy plus acetaminophen, eight patients received quarter-dose titration and acetaminophen, 10 patients received quarter-dose titration and ibuprofen, eight patients received half-dose titration and acetaminophen, and six patients received half-dose titration and ibuprofen. The mean number of acetaminophen doses taken was not statistically different from the mean number of ibuprofen doses taken per patient per week in any dose-titration group over measured time intervals ( p > 0.05). Symptom scores from acetaminophen and ibuprofen dose-titration groups were combined and compared with the no-titration group. The proportion of patients with a mean increase of ≥ 2 from baseline in flu-like symptom score trended lower in the titrated group compared with the no-titration group at 4 hours and 12–15 hours post-injection; these differences reached statistical significance only during the first 2 weeks of treatment ( p = 0.015, quarter-dose vs. no titration).

Conclusion: This study supports the findings of previous studies demonstrating no difference in the effectiveness of acetaminophen and ibuprofen in controlling flu-like symptoms associated with IFNβ treatment in patients with relapsing-remitting MS. Trends in this small pilot study suggest that the combination of initial dose titration and analgesic administration is useful for the reduction of flu-like symptoms with IFNβ‑1a therapy.

Key words: :

• Flu-like symptoms
• Interferon beta
• Management strategies
• Multiple sclerosis