title: [Practical advice for a safe, effective and well tolerated therapy of multiple sclerosis].
abstract: This article provides practical advice how to improve safety, efficacy and tolerability of disease-modifying treatment for multiple sclerosis. The dosage of interferon-beta preparations should be gradually increased during the first weeks of therapy to ameliorate flu-like adverse effects. Analgesics, taken 30 minutes before injection, may alleviate these symptoms a well as injection-associated pain. Correct injection technique, an autoinjector and injection site rotation help to improve skin tolerance. Leukopenia or hepatotoxicity may develop after years of trouble-free therapy. Blood count and liver enzymes should therefore be regularly monitored. With glatiramer acetate, a disturbing but harmless systemic postinjection reaction may occur which should be explained to the patient at the beginning of therapy. Azathioprine is potentially hemato- and hepatotoxic. Transaminases and differential blood count should be frequently checked to ensure the correct dosage. Mitoxantrone is potentially cardiotoxic. An electrocardiogram recording and transthoracic echocardiography should be performed twice a year throughout therapy. With all of these drugs, effective contraception must be used, in particular with mitoxantrone and azathioprine.
authors.affiliation: Neurologische Universitätsklinik, Julius-Maximilians Universität Würzburg. m.buttmann@mail.uni-wuerzburg.de
authors.forename: Mathias
authors.initials: M
authors.lastname: Buttmann
authors.forename: Peter
authors.initials: P
authors.lastname: Rieckmann
mesh_terms: D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D032921:Consensus; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007167:Immunotherapy; D007267:Injections / Q000009:adverse effects / Q000379:methods; D016899:Interferon-beta / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D008991:Monitoring, Physiologic; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000188:drug therapy*; D012449:Safety; D013594:Syringes; D013997:Time Factors; D014944:World Health Organization
chemical_list: D000700:Analgesics; D007155:Immunologic Factors; D016899:Interferon-beta