Switching to Rebif®

CONSIDER THE EFFICACY AND SAFETY PROFILE OF REBIF® WHEN TALKING TO YOUR PATIENTS ABOUT SWITCHING TREATMENT1

Treatment decisions must be determined on a case-by-case basis2

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Key factors when considering de-escalation

According to the 2018 American Academy of Neurology (AAN) practice guideline,* some key considerations when switching DMTs include:

  • Risk of opportunistic infections, including progressive multifocal leukoencephalopathy (PML)3,4
  • Safety and tolerability profile2-4
  • Changes in disease activity3

 

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Risk of opportunistic infection2,3†

  • Different treatment options may be preferred for patients who are at higher risk for serious infections, including PML
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Safety profile and tolerability3

  • The safety profile and clinical experience of a switch DMT
  • The tolerability of a switch DMT
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Changes in disease activity2

  • MRI activity
  • Relapses
  • Disability progression 

 

*Practice guideline: Disease-modifying therapies for adults with multiple sclerosis. Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the AAN. March 6, 2018.

DMT: disease-modifying therapy; RMS: relapsing MS.

 


IMPORTANT SAFETY INFORMATION AND INDICATION

Important Safety Information

Rebif is contraindicated in patients with a history of hypersensitivity to natural or recombinant interferon beta, human albumin, or any other component of the formulation.

Rebif should be used with caution in patients with depression, a condition that is common in people with multiple sclerosis. Depression, suicidal ideation, and suicide attempts have been reported to occur with increased frequency in patients receiving interferon compounds, including Rebif.

Severe liver injury, including some cases of hepatic failure requiring liver transplantation, has been reported rarely in patients taking Rebif. The potential for liver injury should be considered when used in combination with other products associated with liver injury. Monitor liver function tests and patients for signs and symptoms of hepatic injury. Consider discontinuing Rebif if hepatic injury occurs.

Anaphylaxis and other allergic reactions (some severe) have been reported as a rare complication of Rebif. Discontinue Rebif if anaphylaxis occurs.

In controlled clinical trials, injection site reactions occurred more frequently in Rebif-treated patients than in placebo-treated and Avonex-treated patients. Injection site reactions including injection site pain, erythema, edema, cellulitis, abscess, and necrosis have been reported in the postmarketing setting. Do not administer Rebif into affected area until fully healed; if multiple lesions occur, discontinue Rebif until skin lesions are healed.

Decreased peripheral blood counts in all cell lines, including pancytopenia, have been reported in Rebif-treated patients. In controlled clinical trials, leukopenia occurred at a higher frequency in Rebif-treated patients than in placebo and Avonex-treated patients. Thrombocytopenia and anemia occurred more frequently in 44 mcg Rebif-treated patients than in placebo-treated patients. Patients should be monitored for symptoms or signs of decreased blood counts. Monitoring of complete blood and differential white blood cell counts is also recommended.

Cases of thrombotic microangiopathy (TMA), some fatal, have been reported with interferon beta products, including Rebif, up to several weeks or years after starting therapy. Discontinue Rebif if clinical symptoms and laboratory findings consistent with TMA occur, and manage as clinically indicated.

Caution should be exercised when administering Rebif to patients with pre-existing seizure disorders. Seizures have been temporally associated with the use of beta interferons, including Rebif, in clinical trials and in postmarketing reports.

The most common side effects with Rebif are injection-site disorders, headaches, influenza-like symptoms, abdominal pain, depression, elevated liver enzymes, and hematologic abnormalities.

Epidemiological data do not suggest a clear relationship between interferon beta use and major congenital malformations, but interferon beta may cause fetal harm based on animal studies. Data from a large human population-based cohort study, as well as other published studies over several decades, have not identified a drug-associated risk of major birth defects with interferon beta products during early pregnancy. Findings regarding a potential risk for low birth weight or miscarriage with the use of interferon beta products in pregnancy have been inconsistent.

Indication

Rebif is indicated for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults.

Please see Rebif® Prescribing Information  and Medication Guide.

 

References: 1. Rebif® [Prescribing Information]. Rockland, MA: EMD Serono, Inc. 2. Freedman M, Selchen D, Arnold DL, et al. Treatment optimization in MS: Canadian MS Working Group updated recommendations. Can J Neurol Sci. 2013;40(3):307-323. 3. Practice guideline recommendations summary: disease-modifying therapies for adults with multiple sclerosis. American Academy of Neurology. April 2018. Accessed June 16, 2020. https://aan.com/Guidelines/home/GuidelineDetail/898 4. Gajofatto A, Benedetti MD. Treatment strategies for multiple sclerosis: when to start, when to change, when to stop? World J Clin Cases. 2015;3(7):545-555.