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Beta interferon therapy in multiple sclerosis: an audit of patients in North Staffordshire Hospital Trust

Nikki Embrey, MS specialist nurse, North Staffordshire Hospital Trust

Way Ahead 2002;5(4):40-41

Versions of this article were presented by the author and Claire Lowndes, Clinical Nurse Specialist in MS, to the North Staffs Neurology Journal Club and as a poster at the MS Trust conference in November 2002.

Introduction

This article describes the experiences of MS specialist nurses in a disease modifying clinic observing a small cohort of patients in North Staffordshire Hospital Trust.

Beta interferon therapy has been used within the Trust since 1998 following the initiation of the Beta Interferon Consortium Group in the West Midlands. This highlighted a need for MS specialist nurses to educate, initiate and monitor patients with relapsing remitting MS on disease modifying treatments within this region. The Consortium consisted of representatives from 13 Health Authorities in the Region and initially 50 patients commenced therapy. North Staffordshire Hospital Trust treats people within North and South Staffordshire, Shropshire and also manages patients in South Cheshire.

This paper will summarise the experiences of a small cohort of these patients, highlighting the important role the specialist nurse plays in caring for patients on disease modifying therapies.

Many studies have reviewed the clinical effects beta interferon has on patients with MS. Arnason et al (1) reviewed several of these studies concluding that relapse can be reduced by approximately 30% using beta interferon in doses of 18-36 mIU per week. These results also showed a significant/modest reduction in progression of disease as measured by the EDSS (2). There is argument that the drugs reduce attack/relapse frequency, lengthen the time between the first and second attack and limit accumulation of disability after 5 years into disease.

The aim of this study was to assess the effectiveness of beta interferon in the author's locale, compared to the data reviewed by Arnason et al (1). The study evaluates the results of a group of patients who were treated with beta interferon over a four-year period and discusses the patients' responses to treatment.

Demographics

Patients were all diagnosed between 1973 and 1999. Three patients were male and nineteen were female. Treatment was commenced between 1997 and 2000. The duration of time on treatment when the study took place was between 6 and 45 months. The mean time from diagnosis to commencement of treatment was 6.5 years. The mean time on treatment was 28 months.

Design

This was a retrospective study reviewing patients under the care of the MS Team at North Staffordshire NHS Trust, auditing the effectiveness of treatment, monitoring relapse rate and walking distance. Everyone included in the study met the Association of British Neurologists (ABN) Guidelines (3) for relapsing-remitting MS. All three types of beta interferon therapy were used.

Results

  • Mobility remained stable or improved on treatment in 13/22 (60%) of patients.
  • Mobility deteriorated in 9/22 (40%) of patients.
  • Four patients discontinued treatment - three due to progression of disease and one due to side effects of treatment.
  • The average relapse rate pre-treatment in a 24 month period was 2.8.
  • The average relapse rate in the 24 month period post commencement of treatment was 1.7. This represented a 39% reduction in relapse rate.
  • Side effects were experienced by 15/22 (68%) of patients.

Side effects

In general, side effects that most people experience in the first few weeks of treatment become less frequent with time (4). Side effects are experienced in varying degrees. Flu-like symptoms are fairly common, commence up to 4-5 hours post injection, and generally last no longer than 12-24 hours. Patients can also experience headaches, fever, muscle aches, insomnia, injection site reactions and dizziness. Occasionally patients comment that MS symptoms can worsen. Using antipyretics like paracetamol or non-steroidal anti-inflammatory agents like Neurofen or Brufen can alleviate side effects. People often inject before bedtime to combat side effects.

Site reactions may occur with subcutaneous injections. Good injection technique, rotating sites or altering the setting of the auto-injector, can improve reactions in some cases. However, topical steroidal creams, E45 or witch-hazel may also help in extreme cases.

The role of the MS specialist nurse in disease modifying therapies The nurse's role is important in caring for people with MS on disease modifying treatments in all stages of the process.

Screening

  • Ensuring that the patient fulfils the ABN criteria
  • Providing counselling and ensuring that expectations of treatment are realistic
  • Providing information on the need to be committed to treatment and to regular reviews
  • Providing an informed choice of treatment
  • Providing education and management of treatment/side-effects
  • Documenting baseline data and blood tests

Initiating treatment

  • Education in injection technique
  • Monitoring treatment effect/side effects
  • Ensuring compliance
  • Audit
  • Counselling particularly if treatment does not meet expectations
  • Follow-up appointment arranged

Ongoing treatment

  • Providing ongoing education
  • Maintaining ongoing audit
  • Management of relapses

Stopping treatment

  • Ensuring the stopping criteria are applied
  • Counselling
  • Recommending an alternative therapy
  • Ensuring symptom management is reassessed

Discussion

This study has highlighted the effectiveness of beta interferon in people with relapsing remitting MS. The study supports the work undertaken by Arnason et al1 showing a comparable reduction in relapse rate. This study also agrees with previous studies, which suggest that beta interferon can limit the accumulation of disability five years into the disease. It is important that the MS specialist nurse participates in clinical audit programmes, addressing the quality issues that will improve both the patient's experience and outcome (5).

Recommendations

  • Beta interferon is an effective well-tolerated disease modifying therapy in relapsing remitting MS (3).
  • It is recommended that the patients are supported by an MS specialist nurse to aid compliance
  • Written patient information sheets are important to empower the individual

MS specialist nurse numbers have now increased in the West Midlands. Nurses work collaboratively to improve patient information and support for those on disease modifying therapies. Shared care protocols and care pathways are now in place and nurse documentation has also improved.

References

  • 1. Arnason GW, QU, Z-X, Jenson, MA, White, D. Beta interferon: mechanisms of action in relation to clinical effects. International MS Journal 2001;8(2):45-54.
  • 2. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983;18(11):1444-1452.
  • 3. Association of British Neurologists. Guidelines for the use of beta interferon and glatiramer acetate in multiple sclerosis. London: Association of British Neurologists;2001.
  • 4. Burgess M. Multiple sclerosis: theory and practice for nurses. London and Philadephia: Whurr Publishers; 2002.
  • 5. United Kingdom Multiple Sclerosis Specialist Nurse Association, Royal College of Nursing, Multiple Sclerosis (Research) Charitable Trust. Specialist nursing in MS - the way forward: the key elements for developing MS specialist nurse services in the UK. Letchworth and London: Multiple Sclerosis (Research) Charitable Trust and Royal College of Nursing; 2001.

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