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Practical Management of MS in the Primary Care Office Setting

Practical Management of MS in the Primary Care Office Setting. Case Study 3. Case 3 Managing Adverse Events. Ms. M, 23-year-old woman newly diagnosed with MS Initiated on interferon beta-1a IM weekly – 1st dose 48 hours ago

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Practical Management of MS in the Primary Care Office Setting

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  1. Practical Management of MS in the Primary Care Office Setting Case Study 3

  2. Case 3Managing Adverse Events • Ms. M, 23-year-old woman newly diagnosed with MS • Initiated on interferon beta-1a IM weekly – 1st dose 48 hours ago • Calls office today with complaints of horrible flu-like symptoms for over 24 hours after her 1st dose Discussion question: What triage questions should you ask her?

  3. Case 3Triage Questions • Did she premedicate with any pain relievers/antipyretics? • Acetaminophen? NSAID? • Did she take any medication (eg, acetaminophen or NSAID) around the clock after dosing? • What dose of interferon beta-1a did she take?

  4. Case 3Patient Responses • Ms. M did not premedicate • She did not use acetaminophen or NSAID postdose • She gave herself the full dose of interferon beta-1a; she did not know to titrate the dose

  5. Case 3Instructions to Patient • Premedicate with naproxen 500 mg before administering interferon and then dose every 8−12 hours if needed • Reduce interferon beta-1a dose to ½ for 2 weeks, then ¾ dose for 2 weeks, then full dose • Follow up in clinic in about 1 month

  6. Case 3Clinic Follow-Up 5 Weeks Later • Ms. M reports that she tolerated 1/2 dose and 3/4 dose without problem • She is having minor flu-like symptoms with full dose

  7. Case 3Clinic Follow-Up 6 Months Later • Ms. M reports being “laid up” for 24 or more hours each week after interferon beta-1a dose • She is taking naproxen 500 mg before dosing and around the clock afterward • She has skipped the last few interferon doses and is thinking about discontinuing treatment completely because “it is just not worth it” Discussion question: What options would you discuss with her?

  8. Case 3Options Discussed • Switch to a different disease-modifying therapy (especially glatiramer acetate) • Prednisone 10 mg weekly with interferon beta-1a IM dose • No treatment • She should be informed of the benefits of early disease-modifying therapy, which she would be losing by choosing no treatment

  9. Case 3Ms. M’s Choice • Ms. M is engaged in a discussion regarding all of her options • She recognizes the benefits of early treatment, and indicates a desire to continue on some form of MS disease-modifying therapy • She does not want to inject more than once weekly, so she decides to continue interferon beta-1a IM but with the addition of prednisone • Another follow-up is scheduled in 1 month

  10. Case 3Clinic Follow-Up 1 Month Later • Ms. M is tolerating interferon beta-1a at full dose • She has had minimal to no side effects with prednisone

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