Dermatológia pre prax 1/2013

Cutaneous complications of the 1. line immunomodulators in the Multiple Sclerosis treatment

Multiple Sclerosis (MS) is a chronic disease of the central nervous system. The pathogenesis of MS is only partially known, the diagnosis is led by multidisciplinary neurologist. At present we proceed according to the McDonald diagnostic criteria of the disease in 2010 (1). From the definitive clinical forms of MS is the most common relapsing/remitting MS (RRMS). Due to the development of new drugs, called immunomodulators, we also have the option of prophylactic therapeutic intervention in the disease management. The prophylactic use of drugs among the first line interferons beta (IFNβ): IFNβ-1a, Avonex®, IFNβ-1b, Betaferon®, IFNβ-1a, Rebif® and glatirameracetate (GA), Copaxone® – are administered intramuscularly (IM) or subcutaneously (SC) at different regimens and power. In case of insufficient clinical effect of these drugs is possible escalation of the treatment with intravenous mitoxantrone, natalizumab – first monoclonal antibody in the MS treatment or peroral fingolimod. The most common side effects of SC or IM applied IFNβ (using autoinjectors, automatic feeders, filled disposable pens) are except the flu-like syndrome injection-side reactions, we see that after the GA application, too. Significantly affect the patient´s adherence to treatment. The most common injection side reaction is pain, itching, redness lasting several days, in 1-5 % may develop dry tissue necrosis, lipoatrophy, abscess (2). In clinical practise is important to anticipate these complications, special emphasis is placed on nursing management and patient education. The aim of this work is to inform the professionals about the local cutaneous complications of the 1. line immunomodulators in MS treatment.

Keywords: multiple sclerosis, 1. line immunomodulators, injection-side reactions