BEFORE LOOKING AT REBIF®, IT IS IMPORTANT TO REVIEW INTERFERONS

 

IFN-β type 1 is a cytokine that is released by immue cells and is expressed under natural conditions in response to viral infections.1-3

Image showing how interferons work - INF-β TYPE 1 IS A CYTOKINE THAT IS RELEASED BY IMMUNE CELLS AND IS EXPRESSED UNDER NATURAL CONDITIONS IN RESPONSE TO VIRAL INFECTIONS.

 

The amino acid sequence of Rebif® is identical to that of the natural fibroblast-derived human IFN-β4

 

Information icon

This natural presentation allows for a standardized potency assessment of Rebif®4

Rebif® 8.8 mcg, 22 mcg, and 44 mcg contains approximately 2.4 million international units, 6 million international units, or 12 million international units, respectively, of antiviral activity using a reference standard calibrated against the World Health Organization natural interferon beta standard.4

AS A TYPE 1 INTERFERON, REBIF® IS AN IMMUNOMODULATOR

Information icon

The mechanism by which Rebif® exerts its therapeutic effects in RMS patients is unknown4

Shield icon

Type 1 interferons are immunomodulatory agents that are not continuous immunosuppressants3,5

For patients with RMS, the therapeutic effects of IFN-β appear to be driven by influencing processes in both the innate and adaptive immune systems2,3

 

Graphic showing an arrow pointing down on the left with text under saying - REDUCE INFLAMMATORY PROCESSES

REDUCE INFLAMMATORY PROCESSES

This reduction occurs in both the innate and adaptive immune systems.

 

Graphic showing an arrow pointing up on the right with text under saying - INCREASE ANTI-INFLAMMATORY PROCESSES

REDUCE INFLAMMATORY PROCESSES

This reduction occurs in both the innate and adaptive immune systems.

INCREASE
ANTI-INFLAMMATORY PROCESSES

IFN-β increases secretion of several anti-inflammatory cytokines.

IFN-β may address immune dysfunction in MS in the following ways3,5

 

Chart for specifically, INF- β seems to impact both innate and adaptive immune cells in different ways

 

CNS: central nervous system; IFN: interferon; IL: interleukin; RMS: relapsing MS; TFG-β: transforming growth factor β.

 


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. Bashir K, Whitaker JN. Current immunotherapy in multiple sclerosis. Immunol Cell Biol. 1998;76(1):55-64. 2. Hojati Z, Kay M, Dehghanian F. Mechanism of action of interferon beta in treatment of multiple sclerosis. In: Minagar A, ed. Multiple Sclerosis: A Mechanistic View. 1st ed. Cambridge MA: Academic Press; 2015:365-369. 3. Kasper LH, Reder AT. Immunomodulatory activity of interferon-beta. Ann Clin Transl Neurol. 2014.;1(8):622-631. 4. Rebif® [Prescribing Information]. Rockland, MA: EMD Serono, Inc. 5. Giovannoni G. Disease-modifying treatments for early and advanced multiple sclerosis: a new treatment paradigm. Curr Opin Neurol. 2018;31(3):233-243. 6. Warrington R, Waston W, Kim HL, Antonetti FR. An introduction to immunology and immunopathology. Allergy Asthma Clin Immunol. 2011;7(suppl 1):S1. doi: 10.1 186/1710-1492-7-S1-S1. 7. Dendrou CA, Fugger L, Friese MA. Immunopathology of multiple sclerosis. Nat Rev Immunol. 2015;15(9):545-558.