multiple sclerosis condition guide - myprime · 2020-05-19 · “multiple sclerosis is a chronic,...

CONDITION GUIDE

Multiple sclerosis

Introduction and how to use this guide � � � � � � � � � � � � � � � � � � � � � � � � � � � 1

Understanding your multiple sclerosis � � � � � � � � � � � � � � � � � � � � � � � � � � � 3

What is MS? � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4

Four different types of MS � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5

Who is affected? � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 6

What are the symptoms? � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 6

What is a pseudoexacerbation? � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 6

Is MS contagious? � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 6

What are the risk factors? � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 7

Taking care of your body � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 8

Staying mobile with MS � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 9

Staying safe � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 9

Maintaining a healthy weight � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 10

Exercising regularly � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 10

Sleeping well � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 10

Maintaining a healthy weight � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 11

Supporting your emotional health � � � � � � � � � � � � � � � � � � � � � � � � � � 12

Pain and MS � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 14

MS treatment approaches � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 16

Staying on track with your medicines � � � � � � � � � � � � � � � � � � � � � � � 17

Treatment strategies and goals � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 18

Administering your medicine � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 18

Injection-site reactions � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 19

MS medicines � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 20

Other medicines � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 22

Plasma exchange � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 22

The future is bright � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 22

Understanding side effects � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 23

Possible side effects � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 24

When it’s time to call your health care provider � � � � � � � � � � � � � � � 25

Resources and References � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 27

Resources � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 27

References � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 28

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INTRODUCTION AND HOW TO USE THIS GUIDE

How to use this guideWe know the diagnosis of multiple sclerosis (MS) can be overwhelming. This guide can help answer concerns, while giving you important information to share with family or friends.

Your health care provider has suggested that you start treatment. This means that your health care provider believes you have a good chance of responding to medicine. We’re here to help, every step of the way. Remember that taking your medicine as prescribed will help you lead a healthy life. Please do not stop taking your medicine without checking with your health care provider.

Health care providers have learned how to individualize treatment so that each patient has the best chance of responding. The treatment you receive may differ from the treatment of other patients with multiple sclerosis (MS). This is one of the reasons it is so important that you talk about any questions or concerns you may have with your health care provider or with a Prime Therapeutics Specialty Pharmacy™ (Prime Specialty Pharmacy) nurse or pharmacist.

Personal support can help make a challenging journey easier

24/7 ACCESS Visit us online MyPrime.com/SpecialtyA pharmacist is always available to answer questions 877.627.6337 (TTY 711)

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INTRODUCTION AND HOW TO USE THIS GUIDE

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There are four parts to this guide

Understanding your MS

We’re here to help you become a better informed member. In this chapter, we’ll discuss how to live your best life with a MS diagnosis.

Taking care of your body

Find ways to take charge of your health — both physically and mentally — with proactive changes.

MS treatment approaches

Want to learn more about what treatment approaches that your health care provider or the Prime Specialty Pharmacy team might suggest? We’ll go over possible treatment plans, including medicine and other ways to help manage MS in a way that works best for your lifestyle.

Understanding side effects

Learn when to call your health care provider and what tips can help reduce medicine side effects.

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Understanding your MS

Did you know that about 400,000 people in the

United States are living with MS and approximately

10,000 new cases are diagnosed every year.1

Whether you’re newly diagnosed, or you’ve been

living with MS for a while, this guide is all about

helping you become better informed about MS

and your options for staying healthy.

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MYELIN SHEATH

DAMAGED MYELIN

SynapsesCell body

AxonDendrites

Nucleus

UNDERSTANDING YOUR MULTIPLE SCLEROSIS

What is MS?According to the National MS Society, “multiple sclerosis is a chronic, unpredictable disease of the central nervous system (CNS), which is made up of the brain, spinal cord and optic nerves.” MS is thought to be a disorder of the immune system which results in attack on nerve fibers and myelin tissue in the CNS. MS affects the myelin by causing slower and abnormal communication between the brain and the rest of the body in some cases. This damage — called demyelination — prevents your body from communicating completely.

What is myelin?Myelin is a white, fatty substance that forms a protective sheath, or barrier, around the body’s nerve fibers.

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Four different types of MS 1

Relapsing-Remitting MS (RRMS)

This form of MS is the most common. Typically, those with this type of MS experience clearly defined attacks or flare-ups. These are followed by partial or complete recovery periods.2

Secondary-Progressive MS (SPMS)

This form of MS has symptoms that grow worse over time. There may be an occasional flare-up. Most people who are diagnosed with RRMS will transition to SPMS at some point during the lifespan of their disorder.3

Primary-Progressive MS (PPMS)

This form of MS is not very common. It occurs in less than 10% of individuals. PPMS is characterized by slowly worsening symptoms from the beginning, with no relapses or remissions.3

Progressive-Relapsing MS (PRMS)

This is an extremely rare form of MS. It affects less than 5% of the population. PRMS worsens from the beginning, with acute relapses but no remissions. This can occur with or without recovery.2

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Who is affected?The National Institute of Neurological Disorders and Stroke states that most people experience their first symptoms of MS between the ages of 20 and 40. Studies have confirmed that women are at a higher risk for MS, because of a protein called S1PR2. This protein is produced more frequently in the brains of women.4

What are the symptoms? Symptoms of MS may vary from one individual to another. Most persons with MS experience muscle weakness, fatigue, and difficulty with balance. Many individuals with MS notice that symptoms may come and go over time, while others happen regularly. Other symptoms can include:

→ Numbness, prickling, or the feeling of “pins and needles”

→ Pain

→ Speech impediments

→ Tremors

→ Dizziness

→ Hearing loss

Some individuals also experience difficulty with cognitive (brain) functions. These include concentration, memory and judgment.

What is a pseudoexacerbation?A pseudoexacerbation is a temporary flare-up of symptoms that aren’t related to damage in the central nervous system. It rarely lasts more than 24 hours. Most importantly, a pseudoexacerbation does not cause any damage. Keep your body temperature low to minimize the effect of pseudoexacerbations. Symptoms usually go away once your body temperature returns to normal. Common triggers include: hot weather, Jacuzzis or hot tubs, fever, hormone changes and sun exposure.

Is MS contagious? MS is not contagious and cannot be spread from one individual to another.

UNDERSTANDING YOUR MULTIPLE SCLEROSIS

You’re not aloneMS symptoms vary from very minor to quite severe. Some individuals with MS have no symptoms at all. One of the most important reasons for you to continue treatments, even if you feel fine, is that MS can continue to affect your body over time.

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What are the risk factors?Many factors may affect the risk of getting MS. While genetic factors may add to the risk, MS affects more people living farther away from the equator, which suggests geography may play a role. The Mayo Clinic suggests that the following are risk factors:5

→ Age: MS can occur at any age, but most commonly affects people between the ages of 15 and 60.

→ Gender: Women are about twice as likely as men to develop MS.

→ Family history: If one of your parents or siblings has had MS, you are at higher risk of developing the disease.

→ Certain infections: A variety of viruses have been linked to MS, including Epstein-Barr, the virus that causes infectious mononucleosis.

→ Race: Caucasian people, particularly those of Northern European descent, are at highest risk of developing MS. People of Asian, African or Native American descent have the lowest risk.

→ Climate: MS is far more common in countries with temperate climates, including southern Canada, the northern United States, New Zealand, southeastern Australia and Europe.

→ Certain autoimmune diseases: You have a slightly higher risk of developing MS if you have thyroid disease, type 1 diabetes or inflammatory bowel disease.

→ Smoking: Smokers who experience an initial event of symptoms that may signal MS are more likely than nonsmokers to develop a second event that confirms relapsing-remitting MS.

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Taking care of your body

Fortunately, there are ways you can reduce your physical

and mental health stress by being proactive in a few

areas. This includes lifestyle habits to cope with the

symptoms of MS, and maintaining a healthy diet, regular

exercise, a smart sleep schedule and a great emotional

support network.

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Staying mobile with MSMS can cause changes in mobility, often affecting balance and coordination. For our bodies to stay in balance, we need our eyes, ears, brain, sense of body position and perceptions. Ask your health care provider if physical or occupational therapy would be appropriate for you. Or, consider using a device to help you balance, like a cane or a walker.

Staying safe Some of the symptoms of MS, like changes in cognition, mobility and vision, could affect your general safety as well as your safety in an emergency. Think ahead and plan your response so you can proceed safely. The following are some strategies to help you plan:

→ Ask for police and fire safety reviews of your home to identify any possible concerns.

→ Put a visual reminder on the dinner table that will remind you to turn off the stove or the oven.

→ Install electric door locks and an intercom system.

→ Keep electrical cords and cables out of walkways to help prevent trips or falls.

→ Make sure you can get to and use the telephone, doors, window latches and mobility devices, especially when you are at your weakest.

Helping your family and friends understand MSTaking the time to educate family and friends about MS can help alleviate their concerns or fears. Consider talking to your family, friends or loved ones about your lifestyle modification and treatment plans. Including those you care about can also give them a more realistic view of your experience with MS. You can explain to loved ones when you need help and when you prefer to be independent. Remember, you’re not in this alone. Your support group may want to be more helpful than you realize.

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Maintaining a healthy weightThere is no diet that is universally best for people with hepatitis C. Eating a healthy diet gives your body the fuel it needs to perform at its best. Invest the time to learn how to improve your diet.

Good nutrition can help:

→ Improve immune function

→ Reduce inflammation

→ Increase muscle strength

→ Increase energy

→ Stabilize mood

→ Manage fatigue

A balanced diet includes plenty of fruits, vegetables and whole grains. It also limits salt, sugar, saturated fat and alcohol. It may include taking daily vitamins and minerals. Foods rich in omega-3 fatty acids, such as fish, may be helpful in reducing inflammation.

Sleeping wellYour body needs rest to heal and recharge, especially during treatment for MS. One of the best things you can do for your body is to make sure you are getting eight or more hours of sleep each night. If your body is telling you that you’re tired and you are having trouble falling asleep, make sure to mention it to your doctor.

Exercising regularlySome symptoms of MS and prescribed medicines can cause you to feel tired. As strange as it may seem, exercising may actually boost your energy level. It may also help you cope with your condition and manage your weight. Try to exercise regularly.

TAKING CARE OF YOUR BODY

ASK YOUR HEALTH CARE PROVIDER

Ask your health care provider if there are vitamins or minerals that could help to manage your symptoms and keep you healthy� Also, note how your diet affects your symptoms� Try to avoid any foods that seem to increase symptoms�

Talk to your health care provider before taking any nutritional supplements� These can be harmful and life-threatening under some circumstances�

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Maintaining a healthy weight 6

A healthy weight is one that allows your body to function at its best. To find out if your weight is at a healthy level, you should know your body mass index (BMI) — www.nhlbi.nih.gov/health/education/lose-wt/BMI/bicalc.htm. Some people with MS have difficulty maintaining their weight due to side effects from medicine and complications from MS.

According to the National MS Society, some medicines used to treat MS and depression can cause weight gain. It’s important you practice good self-care by eating healthy portions and exercising regularly. Here are four important factors to consider when maintaining your weight:

1 Being overweight can increase MS symptoms such as: fatigue, pressure sores, negative self-image, stress on joints

and demand on heart and lungs. To keep your body functioning at its best, choose healthy options, such as the ones featured

on ChooseMyPlate.gov, a website that helps you choose better meals.

2 Listening to your body is an important step in managing your MS and in living a healthy lifestyle. If you experience cravings, or notice that you’re drawn to certain foods, try and work them into your daily diet plan. Additionally, creating a meal-time plan that allows you to focus on your food with little distraction can help you feel satisfied, full and nurtured.

3 Accountability partners can be a great tool to keep your goals on-track. It may seem too hard to eat healthier or lose weight on your own. Pair up with a workout buddy or an accountability partner to help you discuss hurdles and share celebrations.

4 Create weight loss goals that are sustainable and realistic. Discuss your weight loss goals with your health care provider. Seeking out a nutritionist may also help you to change habits blocking your path to success. In just as little as five minutes a day, you can be off to a great start!

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Supporting your emotional health Maintaining your emotional health can help to support your physical health. Some people become overwhelmed with their diagnosis and the life adjustments they need to make. This is normal. Managing your stress and seeking help from friends, family or professionals are important aspects of staying healthy. Many people also benefit from joining in-person or online support groups.

Stress

Whether you’re newly diagnosed or you’ve been living with MS for some time, at certain points of your treatment you may experience stress. Stress may make the challenges of life difficult to handle — especially when it comes to your body. Here are three great ways you can manage your stress:

Write it down: Record your thoughts in a journal and read through it often. Celebrate daily successes. You are more than this disease.

Take a break: When you’re in the midst of a particularly difficult moment, step back and take a deep breath. Even taking a small nap or watching something you enjoy on TV may help brighten your mood.

Find a support group: Every person needs a healthy balance of people who are able to help in stressful situations. Keep the phone numbers of family or friends you trust handy. Reach out to them as often as needed.


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Depression

Depression is not a character flaw or weakness. It’s a health problem that starts from a chemical imbalance in the brain. If you have thoughts of suicide or of harming yourself or others, call 911 or go to the emergency room.

FOR SUPPORT

National Suicide Prevention Hotline 1�800�273�8255 TTY 1�800�799�4889

Crisis Textline Text “GO” to 741-741

Multiple Sclerosis Society of America Hotline 800�532�7667

National MS Society www�msconnection�org

A note on depressionEveryone feels sad now and then. Sometimes a deep sadness or loss of interest in activities you usually enjoy can actually be a medical illness called depression. Depression can cause deeply sad feelings or high anxiety around every day activities. This may make it hard to live your life the way you want.

If you think you may be depressed, talk with your health care provider. Your health care provider may prescribe an antidepressant medicine to help with your symptoms. Please note that it may take several weeks for you to feel the full benefit of antidepressants. Your health care provider may also recommend counseling for you. It may be helpful to speak to a mental health professional about the impact MS has had on your life.

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Pain and MSMany patients with MS experience different types of pain. Make sure to keep track of your pain, as this information may be useful for you and your health care provider. Many people with MS also have sensory disturbances that may affect movement and balance, such as: discomfort, numbness, tightness, and paresthesia (or, the sensation of “pin pricks” on your skin). If any pain is especially difficult, please discuss with your health care provider. There are three types of pain associated with MS — chronic, primary and secondary.

1 Chronic pain can impact sleep, energy, mood and appetite. Some medicines may help reduce chronic pain related to MS.

2 Primary pain — also called neurogenic pain — results from tissues being weakened. This kind of pain can be sporadic or the result of contact or injury.

LOCATION SENSATION OTHER INFORMATION

Face Sharp or stabbing Also known as trigeminal neuralgia Occurs at any time Often confused with dental pain

Head Dull, sharp, squeezing or throbbing

Caused by demyelination of nerves near the head or neck, or optic nerve

Occurs at any time

Head, scalp, skin Burning, itching or sensitivity

Also known as allodynia Caused by a stimulus, such as touch

Anywhere Burning, aching or “pins and needles”

Most common type of MS pain Triggered spontaneously Usually worse at the end of day

Midsection Dull, hugging sensation around the stomach

Also called the “MS hug” Distracting Persistent


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3 Secondary pain is indirectly caused by MS symptoms. Secondary pain can result from stiff joints, pressure sores, muscle contractions and infection. Secondary pain can improve when one of the underlying causes is treated.

TYPE INFORMATION

Pain resulting from spasticity (when muscles are continuously tight or stiff)

Arises from abnormal use of muscles and joints

Treating the underlying symptom (spasticity) can relieve the secondary pain

Musculoskeletal (the body’s system of muscles, tendons, ligaments, bones and joints)

Often joint pain and back pain

Also known as indirect chronic pain

Occurs at any time

Results from poor posture putting strain on weakened muscles of the lower back

Using a certain posture repeatedly with mobility aids can put stress on the body

Poor physical fitness and muscle strength before diagnosis can make the problem worse

Pain management approaches include physical therapy, massage, stretching and hydrotherapy

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MS treatment approaches

Taking an active role in your health care includes paying

careful attention to both symptoms and treatment. It also

means talking openly with your health care provider.

This part of the guide can help you:

Note your disease symptoms and medicine’s side effects

Understand more about how your condition might affect your quality of life

Understand more about how to get the most from your medicine therapy

Write down questions or concerns to discuss with your health care provider

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Staying on track with your medicines Here is what you can do to help get good results from your MS medicine therapy:

DO

→ Call your health care provider or pharmacist with any questions you may have about your MS medicines.

→ Educate yourself about your MS medicines, especially the risks and warnings.

→ Keep a list of the names and prescribed amounts for each medicine you are taking.

→ Stick to the medicine schedule your health care provider has prescribed.

→ Add taking your medicines into your normal routine.

→ Check with your health care provider before starting any new medicines, including vitamins, supplements, herbal remedies, prescription medicines and over-the-counter products.

→ Drink plenty of fluids, especially before and after an interferon injection treatment. The best choices are water, clear fruit juices

and other caffeine-free drinks.

DON’T

→ Skip or change doses. By taking your medicine as prescribed, you will improve your chances for a positive treatment outcome.


Remember to talk with your health care provider about your lab test results� Make sure you understand what they mean� Don’t be afraid to ask questions if you need further clarification�

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Treatment strategies and goals7

Health care providers have defined different types of responses to MS treatment. They use these response types to determine when an individual may need to change treatment.

Keep in mind that MS is a chronic, progressive condition. This means it can worsen over time, especially if left untreated. Realistic treatment goals include:

→ Slowing the progression of the disorder

→ Reducing the frequency and severity of relapses

→ Improving recovery from relapses

→ Providing relief of symptoms

No medicine can cure MS. Rather, medicines can slow the progression of MS, reduce symptoms and improve your quality of life.

Administering your medicine Some medicines for MS cannot be taken by mouth. Instead, they must be injected under the skin, into a muscle or into a vein. If you’re worried about giving yourself an injection, your doctor, nurse or pharmacist can talk to you about any concerns. They will take the time to demonstrate how to inject your medicine properly and, in many cases, can provide a device that will help.

MS TREATMENT APPROACHES

A note on traveling with disease-modifying drugs8

Have a successful trip by taking time to plan how to travel with your medicines. For security reasons, you may need to show a pre-printed label from your pharmacy to bring the medicine on an airplane. Contact the airlines if you have any questions. Please make sure to keep medicines away from heat and direct sunlight and leave room in your bag for an ice pack or insulation.

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Injection-site reactionsWhen you inject a medicine, a reaction may occur at the injection site. Reactions may include:

→ Redness

→ Swelling

→ Rash

→ Itching

→ Stinging

→ Pain

→ Tingling

→ Discomfort

The following steps may help reduce or prevent these reactions:

STEP EXPLANATION

Preparation Make sure the medicine is at room temperature before injection. Applying ice to the site before and after injection may lessen injection-site reactions. Check with your health care provider prior to using ice after the injection. This may affect the absorption of the medicine.

Method Ensure that you are using the correct injection method for your medicine.

Placement Rotate each new injection site at least 1 inch apart.

Avoid injecting into areas that are swollen, red or hard.

Record when and where you inject each time to help keep track.

Supplies Use a new needle for each injection.

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MS Medicines8

DRUG NAME AVAILABLE FORMS POSSIBLE SIDE EFFECTS IMPORTANT INFORMATION

Aubagio9 (teriflunomide)

Oral tablet Hair loss Diarrhea

Nausea Increased liver enzymes

Headache Reduction in white blood cell count

Never used in patients with liver problems. May cause liver damage.

Avonex10 (interferon beta-1a)

Injection Redness, pain, swelling or bruising at injection site

Muscle aches Fever Chills

Sweating Fatigue Depression

Prefilled syringes or autoinjection devices may be used to help with injections. Rotate injection sites.

Betaseron11

(interferon beta-1b)




Prefilled syringes can be used for injection. Rotate injection sites.

Copaxone12 Glatopa (glatiramer acetate )


Weakness Nausea Joint pain

Infection Muscle stiffness

When injected, flushing, chest pain, heart palpitations, anxiety and trouble breathing can occur if these symptoms do not subside after 15 minutes, seek immediate medical attention. Rotate injection sites.

Extavia13 (interferon-beta-1b)





Gilenya14 (fingolimod)

Oral tablet Back pain Cough Diarrhea

Flu Headache Infection

Liver problems Macular edema (a type of vision problem)

Slow heart rate

The first dose of Gilenya is given in the health care provider’s office or clinic, where you will be observed for six hours. If you stop taking Gilenya for two weeks or more, you will need to start the process over in your health care provider’s office or clinic.

Lemtrada15 (alemtuzumab)

Infusion Flushing Abdominal pain Nausea Diarrhea

Itching Headache Insomnia Urinary tract infections

Fatigue Fever Upper respiratory infections

Must be administered in a health care facility to monitor for serious side effects during and after infusion.

Novantrone16 (mitoxantrone)

Infusion Nausea Mild hair thinning Bladder infection Loss of menstrual periods Mouth sores

Can cause the whites of the eye and nails to turn blue-green

Urine discoloration

May affect heart function May cause an increased risk of developing acute myelogenous leukemia (AML)

Your health care provider will perform certain tests to check that your heart is working normally before starting you on mitoxantrone.

Plegridy17 (peginterferon beta-1a)

Injection Redness, swelling and pain at injection site

Muscle aches Headaches Weakness

Fever Flu-like symptoms

Slight risk of serious heart or liver side effects exists.

Rebif18 (interferon beta-1a)




A prefilled syringe or an autoinjector may be used for injections. Rotate injection sites.

Tecfidera19 (dimethyl fumerate)

Oral tablet Flushing Abdominal pain

Nausea Diarrhea

Slight risk of PML Reduction in white blood cell count

May cause an increased risk for a rare brain infection called progressive multifocal leukoencephalopathy (PML).

Tysabri20 (natalizumab) (fingolimod)

Infusion Headache Infection Pain

Fatigue Diarrhea Rash

Liver damage Increased risk for a rare brain infection called progressive multifocal leukoencephalopathy (PML)

Because of the risk of PML, enrollment in the manufacturer’s TOUCH Prescribing Program is required. Talk to your health care provider or pharmacist for more information.

Zinbryta (daclizumab)


Rash Depression

Fever, chills, sore throat, other flu- or cold-like symptoms

Should not be used in patients with liver problems. May cause liver damage.

This guide is updated annually. Additional drug information can be found on our website at MyPrime.com/specialtyconditions.


21

MS Medicines8

DRUG NAME AVAILABLE FORMS POSSIBLE SIDE EFFECTS IMPORTANT INFORMATION

Aubagio9 (teriflunomide)

Oral tablet Hair loss Diarrhea

Nausea Increased liver enzymes

Headache Reduction in white blood cell count

Never used in patients with liver problems. May cause liver damage.

Avonex10 (interferon beta-1a)




Prefilled syringes or autoinjection devices may be used to help with injections. Rotate injection sites.

Betaseron11

(interferon beta-1b)





Copaxone12 Glatopa (glatiramer acetate )


Weakness Nausea Joint pain

Infection Muscle stiffness

When injected, flushing, chest pain, heart palpitations, anxiety and trouble breathing can occur if these symptoms do not subside after 15 minutes, seek immediate medical attention. Rotate injection sites.

Extavia13 (interferon-beta-1b)





Gilenya14 (fingolimod)

Oral tablet Back pain Cough Diarrhea

Flu Headache Infection

Liver problems Macular edema (a type of vision problem)

Slow heart rate

The first dose of Gilenya is given in the health care provider’s office or clinic, where you will be observed for six hours. If you stop taking Gilenya for two weeks or more, you will need to start the process over in your health care provider’s office or clinic.

Lemtrada15 (alemtuzumab)

Infusion Flushing Abdominal pain Nausea Diarrhea

Itching Headache Insomnia Urinary tract infections

Fatigue Fever Upper respiratory infections

Must be administered in a health care facility to monitor for serious side effects during and after infusion.

Novantrone16 (mitoxantrone)

Infusion Nausea Mild hair thinning Bladder infection Loss of menstrual periods Mouth sores

Can cause the whites of the eye and nails to turn blue-green

Urine discoloration

May affect heart function May cause an increased risk of developing acute myelogenous leukemia (AML)

Your health care provider will perform certain tests to check that your heart is working normally before starting you on mitoxantrone.

Plegridy17 (peginterferon beta-1a)

Injection Redness, swelling and pain at injection site

Muscle aches Headaches Weakness

Fever Flu-like symptoms

Slight risk of serious heart or liver side effects exists.

Rebif18 (interferon beta-1a)




A prefilled syringe or an autoinjector may be used for injections. Rotate injection sites.

Tecfidera19 (dimethyl fumerate)

Oral tablet Flushing Abdominal pain

Nausea Diarrhea

Slight risk of PML Reduction in white blood cell count

May cause an increased risk for a rare brain infection called progressive multifocal leukoencephalopathy (PML).

Tysabri20 (natalizumab) (fingolimod)

Infusion Headache Infection Pain

Fatigue Diarrhea Rash

Liver damage Increased risk for a rare brain infection called progressive multifocal leukoencephalopathy (PML)

Because of the risk of PML, enrollment in the manufacturer’s TOUCH Prescribing Program is required. Talk to your health care provider or pharmacist for more information.

Zinbryta (daclizumab)


Rash Depression

Fever, chills, sore throat, other flu- or cold-like symptoms

Should not be used in patients with liver problems. May cause liver damage.

This guide is updated annually. Additional drug information can be found on our website at MyPrime.com/specialtyconditions.

22


Other medicinesMS treatment may involve other drugs, such as corticosteroids, to treat relapse symptoms.7 Certain medicines are approved by the FDA to treat specific symptoms of MS. For example, Ampyra is approved by the FDA for use in multiple sclerosis patients to improve walking.21

Plasma exchange22

Plasma exchange is another treatment that can be used to manage severe relapses. This treatment is also called plasmapheresis. It may help the patients who do not respond to corticosteroids. Plasma exchange removes the liquid part of a patient’s blood (the plasma) and replaces it with plasma from a healthy donor. This procedure can be costly. It’s best to speak to your health care provider to see if you are a candidate. The risks of the procedure include infection, allergic reaction and abnormal blood clotting.

The future is brightMS studies are happening every day. While health care providers prefer not to use the word “cure” when talking about MS, new treatments and clinical trials are being done year-round to combat this disorder. With new and valuable studies continuing to help health care providers make progress with MS, there is hope for the future. You never know when the next study will offer an incredible discovery. Remember that your body functions best with the right lifestyle choices, good communication with your health care provider and by taking your medicine as prescribed. You can live your best life.

23

Understanding side effects

Some people do not experience any discomfort from their

MS medicine. Others may struggle when dealing with side

effects. MS medicine may affect your mental health and

your body as a whole. Here are the most common side

effects MS patients sometimes face. Remember, if any side

effects have changed your overall quality of life, it’s time to

talk to your health care provider.

24

Possible side effects

1 If you’re having trouble sleeping, consider avoiding large meals or caffeine too close to bedtime. You may also consider developing peaceful bedtime routines that can help your body and mind better relax in the evening. Many people have found that relaxation techniques such as yoga, meditation or deep breathing can help alleviate sleep problems.

2 If you are experiencing regular headaches, consider drinking more fluids — especially water. Some patients have also found that dark rooms or warm baths can help reduce some headache symptoms. Make sure to speak to your health care provider or a pharmacist at Prime Specialty Pharmacy before using an over-the-counter pain reliever.

3 If you are experiencing a fever, make sure you are drinking plenty of fluids. It’s important you talk with your health care provider if you are taking acetaminophen before or after your interferon injections. Remember that any fever lasting more than 48 hours needs to be addressed with your health care provider right away.

4 If you’re experiencing a dry mouth, it’s recommended to start each day with a glass of water. Make sure to get regular dental check-ups and let your dentist know about any medicines you are taking.

A note on nausea and diarrheaSome medicines may cause digestive issues including nausea and diarrhea. When either occur, it’s important you keep your body hydrated and well-rested. For nausea, consider taking small bites of a cracker, or try eating foods at room temperature. For diarrhea, consider limiting foods that contain caffeine, and taking dairy out of your diet, as well as avoiding foods that cause cramping, such as cabbage, beans, onions, green peppers and carbonated drinks.

UNDERSTANDING SIDE EFFECTS

25

When it’s time to call your health care providerChest pain

This includes discomfort in your chest, esophagus (throat) or lungs. This may feel like a burning or aching chest pain. Seek emergency treatment immediately if you develop chest pain while taking MS medicines, especially if the pain is:

→ Very severe

→ Different from pain you have had before

→ Occurs when you are doing a strenuous activity, such as climbing stairs

Shortness of breath

If you feel short of breath, call your health care provider. Your health care provider will determine if it is related to your MS medicines or another medical problem that requires prompt attention.

Vision changes

Although it is uncommon, some people have sudden changes in vision while taking MS medicine. Call your health care provider right away if you develop:

→ Blurry vision

→ Double vision

→ Light sensitivity

Also call your health care provider right away if you experience:

→ Swelling in your legs, feet or ankles

→ Severe diarrhea lasting for more than 48 hours

→ Blood in your stool

→ Skin rash or unusual skin reaction in the area of an injection

→ Fever higher than 100.5° F at any time, or a fever lasting longer than 48 hours

→ Extreme fatigue

→ Allergic-type reactions such as trouble breathing, hives, etc.

→ The injection site does not heal within a few days


If you are experiencing a symptom or side effect that is worrying you, it is always best to call your health care provider� Your doctor will determine if you need immediate attention and the next steps�

26

A note on pregnancy and breastfeeding23 Let your health care provider know if you are pregnant or planning to become pregnant. Some MS medicines are not recommended for pregnant women. Your health care provider may advise you to stop taking certain medicines during pregnancy.

Years ago, women with MS were told to avoid becoming pregnant. People thought pregnancy could make MS symptoms worse. Actually, many pregnant women with MS experience fewer relapses. This is especially true during the second and third trimesters. However, about 20 to 40 percent of women experience a relapse three to six months after giving birth. These relapses are usually temporary.

UNDERSTANDING SIDE EFFECTS

27

ResourcesORGANIZATION DESCRIPTION

ABLEDATA abledata.com 800.227.0216

ABLEDATA provides objective information about assistive technology products and rehabilitation equipment available from domestic and international sources. Although ABLEDATA does not sell any products, the organization can help you locate the companies that do.

American Chronic Pain Association theacpa.org 800.533.3231

ACPA offers support and education for those with chronic pain and their families.

Multiple Sclerosis Association of America msassociation.org 800.532.7667

MSAA is a national nonprofit organization dedicated to enriching the quality of life for everyone affected by multiple sclerosis. It provides ongoing support and direct services

to individuals with MS and the people close to them.

Mayo Clinic mayoclinic.com

The Mayo Clinic is a nonprofit medical practice and research group based in Minnesota.

National Institute of Neurological Disorders and Stroke ninds.nih.gov/disorders/ multiple_sclerosis

The mission of the National Institute of Neurological Disorders and Stroke is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease.

National Multiple Sclerosis Society nationalmssociety.org

The National MS Society is a non-profit dedicated to education about MS and eliminating the disorder.

Patient Advocate Foundation patientadvocate.org

Patient Advocate Foundation (PAF) is a national 501 (c)(3) non-profit organization which provides professional case management services to Americans with chronic, life threatening and debilitating illnesses.

U.S. National Library of Medicine nlm.nih.gov

The U.S. National Library of Medicine website features online materials about medical issues, disorders and treatments.

RESOURCES

28

References1. MultipleSclerosis.net. www.https://multiplesclerosis.net/what-is-ms/statistics/. Accessed 1/18/2017.

2. Hooper, K. Managing Progressive MS. New York, NY: National Multiple Sclerosis Society; 2011.

3. Multiple Sclerosis: Just the Facts. New York, NY; National Multiple Sclerosis Society; 2011.

4. “Why Do More Women Than Men Get MS?” Healthline. Accessed 9/10/2015. www.healthline.com/ health-news/why-do-more-women-than-men-get-ms-051414

5. Risk Factors. (n.d.) Mayo Clinic. Retrieved from www.mayoclinic.org/diseases-conditions/multiple-sclerorsis/symptoms-causes/dxc-20131884x. Accessed 9/10/2015.

6. Take Control of Your Weight Gain. (n.d.) National Multiple Sclerosis Society. Retrieved from www.nationalmssociety.org/Living-Well-With-MS/Health-Wellness/Diet-Nutrition/Take-Control-of-Your-Weight. Accessed 9/24/30.

7. Managing relapses. (n.d.) National Multiple Sclerosis Society. Retrieved from www.nationalmssociety.org/ Treating-MS/Managing-Relapses. Accessed 9/30/2015.

8. National Multiple Sclerosis Society. (2012.) The MS Disease-Modifying Medications [Brochure]. www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Brochures/Brochure-The-MS-Disease-Modifying-Medications.pdf

9. Aubagio prescribing information. Truven Health Analytics, Micromedex Solutions database. www.micromedexsolutions.com/micromedex2/librarian/ND_T/evidencexpert. Search term: Aubagio. Accessed 5/11/15.

10. Avonex Medication Guide. [pdf] Avonex March 2012. www.avonex.com/pdfs/Avonex_Medication_Guide.pdf. Accessed 9/30/2015.

11. Betaseron prescribing information [pdf]. November, 2014. http://labeling.bayerhealthcare.com/html/products/pi/Betaseron_PI.pdf

12. Highlights of Prescribing Information [pdf]. July 2010. www.copaxone.com/Resources/pdfs/PrescribingInformation.pdf. Accessed 9/30/2015.

13. Extavia prescribing information [pdf]. December 2014. www.pharma.us.novartis.com/product/pi/pdf/extavia.pdf. Accessed 9/30/2015.

REFERENCES

29

14. Gilenya prescribing information [pdf]. August 2015. www.pharma.us.novartis.com/product/pi/pdf/gilenya.pdf. Accessed 9/30/2015.

15. Lemtrada prescribing information. Truven Health Analytics, Micromedex Solutions database. www.micromedexsolutions.com/micromedex2/librarian/ND_T/evidencexpert. Search term: Lemtrada. Accessed 5/11/15.

16. Novantrone (mitoxantrone) prescribing information. www.micromedexsolutions.com/micromedex2/librarian/ND_T/evidencexpert. Search term: Novantrone. Accessed 9/30/2015.

17. Plegridy prescribing information. Truven Health Analytics, Micromedex Solutions database. www.micromedexsolutions.com/micromedex2/librarian/ND_T/evidencexpert. Search term: Plegridy. Accessed 5/11/15.

18. Rebif Prescribing Information [pdf]. MS LifeLines. March 2012. www.emdserono.com/ms.country.us/en/images/Rebif_PI_tcm115_140051.pdf. Accessed 9/30/2015.

19. Tecfidera prescribing information. Truven Health Analytics, Micromedex Solutions database. www.micromedexsolutions.com/micromedex2/librarian/ND_T/evidencexpert. Search term: Tecfidera. Accessed 5/11/15.

20. Tysabri prescribing information [pdf]. May 2015. www.tysabri.com/prescribingInfo. Accessed 9/30/2015.

21. Ampyra Medication Guide [pdf] December, 2015. www.ampyra.com/prescribing-information.pdf. Accessed 9/30/2015.

22. Medications for managing relapses. (n.d.) National Multiple Sclerosis Society. Retrieved from www.nationalmssociety.org/Treating-MS/Managing-Relapses/Plasmapheresis. Accessed 9/30/2015.

23. Pregnancy and reproductive issues. (n.d.) National Multiple Sclerosis Society. Retrieved from www.nationalmssociety.org/Living-Well-With-MS/Family-and-Relationships/Pregnancy. Accessed 9/24/2015.

30

NOTES

31

NOTES

32

Prime Therapeutics Specialty Pharmacy LLC (Prime Specialty Pharmacy) is a wholly owned subsidiary of Prime Therapeutics LLC (Prime). Prime Specialty Pharmacy works with your health plan to provide the specialty medicines you need. Prime Specialty Pharmacy wants to help you get the most from your medicine therapy by:

→ Helping you get the medicines you need, when you need them

→ Providing ongoing, personalized support from disease-specific experts

→ Helping you manage the details so your condition does not manage you

NOTES

3333

→ This guide provides an overview of multiple sclerosis� It is not meant to replace medical advice from your doctor, pharmacist or other health care provider� Please contact them for more information� This guide is intended to be accurate� However, Prime Therapeutics and Prime Specialty Pharmacy are not responsible for loss or damage due to reliance on this guide�

ABOUT PRIME THERAPEUTICS SPECIALTY PHARMACY

We are trusted by your health plan to help you get the medicine you need to feel better and live well. Our pharmacy experts are working hard to make your medicine more affordable, and your experience easier.

We are fully accredited by URAC — Specialty Pharmacy Accreditation and ACHC (Accreditation Commission for Healthcare) — Specialty Pharmacy Accreditation.

For more information on Prime Specialty Pharmacy, call 877.627.6337 (TTY 711) or visit us at MyPrime.com/Specialty.

All brand names are the property of their respective owners.

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