8.2.4 Other immunomodulating drugs

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First line drugs

Second line drugs

Specialist drugs

Secondary care drugs

Interferon alfa

Interferon alfa – 2a

Roferon-A pre-filled syringe 3 million units, 6 million units, 9 million units, 18 million units.
Roferon-A cartridge 18 million unit in 0.6ml

Interferon alfa – 2b

IntronA 1.5ml cartridge 15 million units/ml, 25 million units/ml, 50 million units/ml
IntronA 10 million units vial powder for reconstitution
Roferon-A cartridge 18 million unil/ml

Peginterferon alfa

Peginterferon alfa - 2a

Pre-filled syrings 180 microgram

Peginterferon alfa – 2b

Injection 80 microgram vial, 100 microgram vial, 120 microgram vial, 150 microgram vial

Interferon beta

Interferon beta – 1a

Avonex pre-filled syringe 30 microgram (6 million units)
Rebif pre-filled syringe 22 microgram (6 million units), 44 microgram (12 million units)

Interferon beta – 1b

Betaferon injection 300 microgram (9.6 million unit) vial

Note: Interferon beta and glatriamer are only to be used as part of the Risk Care Scheme.

Side effects in addition to those listed in Adverse effects (Click here)
With interferon the patient may experience symptoms of a flu-like illness and headaches, more common with the start of treatment and reduce with continued use. Dizziness, pins and needles, trembling, numbness, sleep disturbances, anxiety states, forgetfulness, drowsiness, confusion, depression, and suicidal behaviour have occurred.

NICE: Interferon and glatiramer for multiple sclerosis (Jan 2002)

Bacillus Calmette-Guérin

ImmuCyst^® bladder instillation 81mg vial

Fingolimod

Capsules 500 micrograms

For use in line with NICE: Fingolimod for the treatment of highly active relapsing–remitting multiple sclerosis (April 2012)

Glatiramer Acetate

Injection 20mg in 1ml

Lenalidomide

Capsules 5mg, 10mg, 15mg, 25mg

For use in line with NICE: Lenalidomide for the treatment of multiple myeloma (June 2009)

Notes (Drug Safety Update Feb 2011 vol 4, issue 7: A3):

Patients receiving lenalidomide for the management of multiple myeloma should be closely monitored for evidence of arterial and venous thromboembolic events
Modifiable risk factors for thromboembolic events should be managed wherever possible (eg, smoking cessation; control of hypertension and hyperlipidaemia)
Medicines that may increase the risk of thromboembolism, such as oestrogens and erythropoietic agents, should be used with caution during lenalidomide treatment
Appropriate thrombotic prophylaxis medication should be considered during lenalidomide treatment, particularly in patients with multiple thrombotic risk factors, after careful assessment of the balance of risks and benefits in individual patients
Treatment with lenalidomide must be discontinued and anticoagulation therapy started in patients who experience thromboembolic events. Once the patient has been stabilised on anticoagulation treatment and any complications of the thromboembolic event have been managed, lenalidomide may be restarted at the original dose, after a reassessment of risks and benefits of treatment. Anticoagulation should then be continued throughout the course of lenalidomide treatment.

Thalidomide

Capsules 50mg
Original pack prescribing / dispensing only

For use in line with NICE: Bortezomib and thalidomide for the first-line treatment of multiple myeloma (July 2011)

MHRA Drug Safety Update July 2011 vol 4, issue 12:

Patients treated with thalidomide have an increased risk of arterial thromboembolism, including myocardial infarction and cerebrovascular events, in addition to the established risk of venous thromboembolism

Action should be taken to minimise all modifiable risk factors for thromboembolic events (eg, smoking, hypertension, and hyperlipidaemia)

Healthcare professionals should consider venous and arterial thrombotic risk and administer antithrombotic prophylaxis for at least the first 5 months in patients commencing thalidomide