【病例学习第21期】Multiple Sclerosis多发性硬化症

From Pharmacy Times(www.pharmacytimes.com)
Thanks to the author Craig I. Coleman, PharmD(Dr. Coleman is an assistant professor of pharmacy practice and director of the pharmacoeconomics and outcomes studies group at the University of Connecticut School of Pharmacy.)

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Multiple Sclerosis

AP, a 33-year-old woman recently diagnosed with relapsing-remitting multiple sclerosis (RRMS) comes to the pharmacy counter with her first prescription for interferon beta-1b (Betaseron) 0.25 mg subcutaneously every other day. The diagnosis of RRMS was made a few weeks prior, after AP began complaining of bouts of changes in sensation, muscle weakness, fatigue, and unsteadiness on her feet. At present, AP clearly looks overwhelmed by her recent diagnosis and appears apprehensive about taking this new medication. What counseling should the pharmacist provide to AP as a patient new to interferon treatment?

ANSWER

Beta-interferons (IFN-bs), including IFN-b-1b (Betaseron), are first-line treatments (as is glatiramer acetate) for patients with RRMS (characterized by clearly defined relapses with full recovery or with sequelae and residual deficit upon recovery, but no disease progression during the relapses). Other commonly used treatments include natalizumab and mitoxantrone; however, due to their associated toxicities, these agents are typically reserved for those who fail IFN-bs or glatiramer. The pharmacist should counsel AP that, because most of the immune response in RRMS occurs early in the disease course, it is commonly accepted that treatment should begin early. Although IFN-bs will not stop the disease or make her feel better, they will decrease her relapse rate and slow the progression of the disability associated with RRMS. The pharmacist should also counsel AP that side effects, including reactions at the site of injection and flu-like symptoms, will likely occur. These side effects are best treated with OTC ibuprofen. Acetaminophen may also be used to treat these side effects, but its routine use should probably be avoided, as it may increase the risk of asymptomatic liver dysfunction commonly associated with IFN-b use.


多发性硬化症
AP，一名33岁女子最近因被诊断为复发—缓解型多发性硬化症（RRMS）而首次开始使用干扰素β- 1b（Betaseron）0.25毫克皮下注射，每隔一天一次。在AP被诊断为RRMS数周后，AP发现身体感觉有变化，肌肉无力、疲劳、脚抖。目前，AP由于被诊断为RRMS而深受打击，又因首次使用干扰素β- 1b身体感觉出现异常而非常担忧。对于像AP这样首次使用干扰素β- 1b治疗的患者，药师应如何建议？
答案
β-干扰素（IFN-bs）的，包括IFN-b-1b（Betaseron），是RRMS（完全恢复与留有后遗症和未完全康复病症特点明显，复发时病情没有进一步恶化）患者的一线治疗药物（如醋酸格拉默）。其他常用的治疗药物包括那他珠单抗和米托蒽醌，但由于其累加毒性，这些类药物通常只作为IFN-bs或格拉默治疗无效的患者的替代药物。药剂师应告知AP，由于在RRMS发生免疫反应是在疾病的的最早期过程中，治疗应尽早开始。虽然IFN-bs不会阻止的疾病发作或使她感觉更好，但能使复发率下降并延缓RRMS病情恶化，避免引起残疾。药剂师也应告知AP IFN-bs的副作用，例如注射部位反应和感冒类症状很可能会发生。这些副作用可首选OTC药物布洛芬治疗。对乙酰氨基酚也可用于治疗这些副作用，但其日常使用应避免，因为对乙酰氨基酚与IFN-bs联用可能会增加无症状肝损伤风险。

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多发性硬化症
AP，一名33岁女子最近因被诊断为复发—缓解型多发性硬化症（RRMS）而首次开始使用干扰素β- 1b（Betaseron）0.25毫克皮下注射，每隔一天一次。在AP被诊断为RRMS数周后，AP发现身体感觉有变化，肌肉无力、疲劳、脚抖。目前，AP由于被诊断为RRMS而深受打击，又因首次使用干扰素β- 1b身体感觉出现异常而非常担忧。对于像AP这样首次使用干扰素β- 1b治疗的患者，药师应如何建议？
答案
β-干扰素（IFN-bs）的，包括IFN-b-1b（Betaseron），是RRMS（完全恢复与留有后遗症和未完全康复病症特点明显，复发时病情没有进一步恶化）患者的一线治疗药物（如醋酸格拉默）。其他常用的治疗药物包括那他珠单抗和米托蒽醌，但由于其累加毒性，这些类药物通常只作为IFN-bs或格拉默治疗无效的患者的替代药物。药剂师应告知AP，由于在RRMS发生免疫反应是在疾病的的最早期过程中，治疗应尽早开始。虽然IFN-bs不会阻止的疾病发作或使她感觉更好，但能使复发率下降并延缓RRMS病情恶化，避免引起残疾。药剂师也应告知AP IFN-bs的副作用，例如注射部位反应和感冒类症状很可能会发生。这些副作用可首选OTC药物布洛芬治疗。对乙酰氨基酚也可用于治疗这些副作用，但其日常使用应避免，因为对乙酰氨基酚与IFN-bs联用可能会增加无症状肝损伤风险。