While the available Disease-Modifying Drugs (DMDs) differ in terms of efficacy and overall benefits to people with MS, they also differ in terms of dose, frequency and mode of administration. Of the DMDs, interferon beta-1a (Rebif®), Interferon beta-1b (Betaseron®), and glatiramer acetate (Copaxone®) are injected subcutaneously (into the fatty layer just beneath the skin). Interferon beta-1a (Avonex®) is injected intramuscularly (deeper than subcutaneous injections and into the muscle).
A thorough training by nurses at the start of therapy, regular follow-ups and good support are important to help people with MS manage their injections properly. Any injection-site reactions that occur after injecting are generally mild, and rarely give cause for stopping treatment. (See below for more details on managing injection-site reactions.)
Training in self-injections
All currently available disease-modifying drugs must be given by injection, which requires regular administration. Because of this, people with MS and their families and partners need to be taught the following skills to ensure optimal treatment outcomes:
- Correct handling and storage of drugs according to the manufacturer’s recommendations
- Injection-site selection and rotation, and injection-site management
- Self-injection techniques
- Monitoring and management of treatment-related side-effects
For more information and recommendations please contact your local manufacturer for further product information.
The first stage is to determine whether it is the person with MS that gives the first injection, or whether it is a nurse or family member. Ideally, the person with MS should perform the injection, under close supervision from the nurse. It is subsequently important that the person receiving treatment is clear about the administration regimen, especially during the initial treatment period. It is also important that the person receiving treatment understands the implications of under- or over-dosing.
The instruction of a safe, clean self-injection technique with appropriate site selection and rotation is important. This will help reduce the occurrence and severity of erythema and possible necrosis at the injection site. (Read on for more about this topic, below)
Injection-site reactions
Cutaneous reactions
The most common cutaneous reactions to injection are redness, swelling, itching, or a lump at the injection site. These reactions are usually mild, improve over time, seldom require medical care, and occur less frequently with intramuscular injections.
Muscle reactions
Muscle aches have been reported in patients receiving interferon beta-1a and interferon beta-1b.
Pain
All therapies may induce some pain at the site of injection, though it rarely leads to the cessation of treatment. Symptoms may occur immediately following injection or develop up to 24–48 hours after.
Skin necrosis
Although injection-site necrosis (breakdown of skin tissue) is a rare side-effect of treatment with interferon beta, serious complications such as infection and tissue loss may develop at the affected site. It is therefore important for this condition to be identified early and treated appropriately.
Managing injection-site reactions
A number of nursing interventions help to limit the occurrence of injection-site reactions:
Injection technique (subcutaneous injections)
- Use the proper injection technique as instructed by a nurse or physician
- Apply ice to area before and after injection
- Gently massage area after injection for at least two minutes. This helps disperse medicine and reduce irritation
- Inject only into healthy tissue
- Wait at least seven days before injecting in the same spot
- Check the site for redness, tenderness, or swelling two hours after injection.
- Rotate injection sites and select subcutaneous sites that are preferred or are most comfortable. (View an image of possible subcutaneous sites, below)
- Avoid over-exposure to sunlight or ultraviolet rays
- Use an analgesic as required (although you should check the most appropriate analgesic regimen with a doctor or nurse)
- Where possible and when available, some people may wish to consider using an auto-injector to increase convenience, comfort and compliance.
View possible subcutaneous sites
View an illustration of injections depths for administration
