233 Nursing Assessment, Management and Treatment of Autoimmune Diseases
to treat worsening MS (Johns Hopkins Medicine, n.d.). The FDA-approved preventive therapies include the following (Johns Hopkins Medicine, n.d.; Rebar et al., 2019): ● Interferon beta-1-a : This beta interferon is given once a week by intramuscular (IM) injection or beta interferon administered via injection under the skin three times a week. ● Interferon beta-1b : This therapy may be administered via injection every other day. Frequency depends on specific therapy and patient needs. | NURSING CONSIDERATION Interferon betas have various side effects. In addition to redness and discomfort at the injection site, side effects include fever, chills, achiness, fatigue, depression, and changes in liver function. While patients are re- ceiving interferon, they need to be monitored for changes in liver func- tion on a regular basis. All interferons work by interfering with the immune system’s ability to cause inflammatory processes (Johns Hopkins Medicine, n.d.). ● Glatiramer acetate : This drug is a synthetic protein that is similar to a component of myelin. Given subcutaneously, glatiramer acetate is believed to work by modifying the immune system so that it produces more anti-inflammation immune cells. Side effects include redness, swelling, and itching at the injection site. A small number of patients may experience a “post injection reaction,” which is a brief period of
flushing, racing of the heart, feeling faint, and shortness of breath. ● Natalizumab : Natalizumab is a monoclonal antibody administered intravenously once every 4 weeks. This drug is believed to work by preventing lymphocytes from entering the CNS. Natalizumab may produce a rare, but serious, possibly fatal, infection of the brain called progressive multifocal leukoencephalopathy (PML). ● Mitoxantrone : Mitoxantrone is a chemotherapeutic drug that is used for patients experiencing worsening forms of relapsing MS and secondary progressive MS. It is given intravenously every 3 months. The potential for toxicity is high, so patients may receive a limited number of doses throughout their lifespan. The drug is believed to work by suppressing the immune system to reduce the number of immune cells that might be causing inflammation. Mitoxantrone is associated with cardiotoxicity. There are also a number of oral medica- tions administered to reduce relapse rates. These include the following (Comerford & Durkin, 2021; Mayo Clinic, 2020b): ● Fingolimod (Gilenya) : This drug is taken once daily. The patient’s heart rate and blood pressure are monitored for 6 hours after the first dose because there is the potential for reduction in heart rate. Additional side effects include infections, headaches, hypertension, and blurred vision. ● Teriflunomide (Aubagio) : This is an oral medication taken once daily to reduce relapse rates. Teriflunomide can cause liver damage and hair loss, when taken by men or women or birth
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