How effective are "First Generation" DMTs?
Dr. Bourdette explains that interferons and glatiramer acetate are roughly equally effective. But effectiveness varies for different people. In studies that were done with large numbers of patients, these drugs decreased the frequency of relapses by about 33% and decreased the risk of becoming more disabled over two to three years by about 30%. But the effectives for individual patients vary. Some patients that have been on an interferon or glatiramer acetate for 10, 15 years who’ve been absolutely stable on those medications and those drugs are highly effective in that subgroup. Other people continue to have quite active MS despite being on one or the other of those drugs and then people in between. There’s a spectrum of response to the therapies with some people responding extremely well to them and others not so well.
As far as side effects are concerned, after 15 years of experience with these therapies, there have been no serious unexpected life threatening problems. So there’s a long-term history of safety. There are side effects though. For the beta interferons particularly when starting the drugs patients will experience flu like side effect. They may have fever, muscle aches and fatigue. This can usually be controlled by escalating the dose and by using non-steroidal anti-inflammatory drugs and it usually gets better over time. The subcutaneous forms of interferons can cause injection site reactions, which usually are mild, but sometimes can be more severe. Glatiramer acetate again is the non-interferon, it does not cause the flu like side effects that you see with the interferons and it doesn’t cause laboratory abnormalities, so patients don’t have to have blood monitoring. They do get injection site reaction and medicine stings initially when they inject it and they have to give it once a day. They can get red spots that sometimes can be quite vigorous.
After two years of therapy some people develop lipoatrophy at the injections sites and that can be cosmetically a problem. The patients can also have an acute post injection reaction where they feel short of breath which can be very frightening. It usually only occurs once or twice with an injection. These are all in general manageable side effects for these medications. (3.5 minutes)
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