Drug safety during the pandemic
The COVID pandemic has focussed attention on some of the measures needed to maintain health and wellbeing in our daily lives. Wearing a mask and maintaining physical distance are especially important for people with MS who may have a higher risk of infection because of the medications they are taking.
While COVID concerns are very real, the pandemic can distract people from other important safety measures that are needed during treatment. Routine safety monitoring – usually blood tests but other procedures as well – are needed to identify if a problem is developing so appropriate measures can be taken. Admittedly, these tests can be a nuisance and people don’t always adhere to the monitoring schedule. For example, a recent study in British Columbia looked at 1,016 people taking an oral medication for their MS – either Aubagio, Tecfidera or Gilenya (Ng and colleagues. Mult Scler 2021;27:239-249). About 90% of people had the required blood test before starting treatment, but things quickly went downhill from there. For the follow-up test at one month needed for Aubagio, only 40% had the test. For the three-month test for Gilenya, only 1 in 3 showed up. The less frequent testing needed for Tecfidera – a blood test at 6 months – met with greater success: 89% of people got the test done.
Most medications are broken down by the liver so a common reason for blood tests is to ensure that the liver is functioning normally. Another reason to test the blood is to check blood cell counts. Of particular importance are lymphocytes, which are immune cells that appear to be involved in the MS disease process. Most MS drugs lower the lymphocyte count as a way of controlling the disease. However, if the lymphocyte count gets too low, there can be a higher risk of infection – an important consideration during the COVID pandemic.
Some health test, such as blood pressure measurements, can be done at home or at a pharmacy. This is important because people with MS are more prone to high blood pressure. A recent analysis of over 37 million health records (including over 100,000 people with MS) found that people with MS were 25% more likely to have high blood pressure compared to people without MS (Briggs and colleagues. Eur J Neurol 2021;28:558-566) – a factor that contributes to the higher rate of heart disease in people with MS (Marrie and colleagues. Neurol Clin Pract 2016;6:120-128). Hypertension was especially common in men and African-Americans with MS.
Since regular safety monitoring is important to maintain your health and wellbeing, we’ve put together a list of what is recommended during treatment with a disease-modifying therapy for MS. This is just a general guide – your doctor may follow a different monitoring schedule.
- Interferons (Avonex, Betaseron, Extavia, Rebif, Plegridy): Periodic blood tests (according to the schedule set by your doctor). Check blood pressure periodically.
- Copaxone (and generic glatiramer acetate): No routine testing is required. Check blood pressure periodically.
- Aubagio: Blood tests are needed every month for at least 6 months when starting treatment and periodically thereafter. Check blood pressure periodically.
- Tecfidera: Blood test and urine sample are needed after 6 months on treatment then every 6-12 months thereafter.
- Gilenya (and generic fingolimod): Blood tests every 3 months are needed in the first year of treatment then periodically thereafter. An eye exam is required 3-4 months after starting treatment; additional exams may be needed if there are eye symptoms.
- Mayzent: A blood test is required in the first 3 months after starting treatment and periodically thereafter. Check blood pressure periodically. Some people may require periodic eye exams.
- Zeposia: A blood test is required in the first 3 months after starting treatment and periodically thereafter. Check blood pressure periodically (and avoid foods containing tyramine). Some people may require periodic eye exams.
- Mavenclad: A blood test is required before you receive Year 2 dosing.
- Tysabri: Periodic blood tests (e.g. every 6 months) are recommended. More frequent MRIs (e.g. every 3-6 months) may be needed.
- Ocrevus: No procedures are required.
- Kesimpta: No procedures are required.
- Lemtrada: Blood tests and urine samples are needed every month and for at least 48 months after the last dose. An electrocardiogram (ECG) is needed before each treatment course. A skin exam is needed once a year.
In addition to these tests and procedures, doctors typically order an MRI about 6-9 months after you start a treatment and periodically thereafter.
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