title: Nurses' perspective on approaches to limit flu-like symptoms during interferon therapy for multiple sclerosis.
abstract: BACKGROUND
  Several interferon beta (IFNβ) formulations are approved for first-line use as disease-modifying therapies to treat patients with multiple sclerosis (MS). Systemic post-injection reactions, often termed flu-like symptoms (FLS), occur in approximately half of all patients treated with IFNβs and can affect adherence to therapy. These symptoms, which include pyrexia, chills, malaise, myalgia, and headaches, usually resolve within 24 hours or persist intermittently following each injection. Because FLS, which usually occur early in the treatment course and diminish over time, are a primary cause of nonadherence to IFNβ therapy, it is important to employ strategies that can attenuate these side effects.
  
  
  METHODS
  To identify interventions effective in limiting FLS, a panel of United States-based nurses with expertise in MS patient care was convened and a literature review completed.
  
  
  RESULTS
  Panel consensus was reached on specific interventions that can attenuate FLS. These prevention and mitigation strategies include dose titration, analgesia, and optimal injection timing, as well as other techniques that panel members have found useful in their clinical practice experience.
  
  
  CONCLUSIONS
  These measures, in addition to effective patient education, will help to reduce the incidence of FLS secondary to IFNβ therapy, improve patient medication adherence, and positively affect long-term clinical outcomes.
authors.affiliation: College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA (MLF); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Forget-Me-Not Home Memory Care, Raleigh, NC, USA) (JB); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Rush Multiple Sclerosis Center, Chicago, IL, USA) (RTB); Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA (KC); Acadia Neurology Center, Acadia, CA, USA (GCH); Providence Multiple Sclerosis Center, Providence St. Vincent Medical Center, Portland, OR, USA (KH); Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, OH, USA (MN); Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA (substantial portion of contributions made while employed at Texas Neurology, Dallas, TX, USA) (SO); and Clinical Center for Multiple Sclerosis, Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA (GR). Kay Hartley is now with Providence Home Health, Portland, OR, USA.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Filipi
authors.affiliation: College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA (MLF); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Forget-Me-Not Home Memory Care, Raleigh, NC, USA) (JB); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Rush Multiple Sclerosis Center, Chicago, IL, USA) (RTB); Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA (KC); Acadia Neurology Center, Acadia, CA, USA (GCH); Providence Multiple Sclerosis Center, Providence St. Vincent Medical Center, Portland, OR, USA (KH); Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, OH, USA (MN); Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA (substantial portion of contributions made while employed at Texas Neurology, Dallas, TX, USA) (SO); and Clinical Center for Multiple Sclerosis, Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA (GR). Kay Hartley is now with Providence Home Health, Portland, OR, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Beavin
authors.affiliation: College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA (MLF); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Forget-Me-Not Home Memory Care, Raleigh, NC, USA) (JB); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Rush Multiple Sclerosis Center, Chicago, IL, USA) (RTB); Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA (KC); Acadia Neurology Center, Acadia, CA, USA (GCH); Providence Multiple Sclerosis Center, Providence St. Vincent Medical Center, Portland, OR, USA (KH); Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, OH, USA (MN); Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA (substantial portion of contributions made while employed at Texas Neurology, Dallas, TX, USA) (SO); and Clinical Center for Multiple Sclerosis, Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA (GR). Kay Hartley is now with Providence Home Health, Portland, OR, USA.
authors.forename: Raquel T
authors.initials: RT
authors.lastname: Brillante
authors.affiliation: College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA (MLF); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Forget-Me-Not Home Memory Care, Raleigh, NC, USA) (JB); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Rush Multiple Sclerosis Center, Chicago, IL, USA) (RTB); Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA (KC); Acadia Neurology Center, Acadia, CA, USA (GCH); Providence Multiple Sclerosis Center, Providence St. Vincent Medical Center, Portland, OR, USA (KH); Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, OH, USA (MN); Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA (substantial portion of contributions made while employed at Texas Neurology, Dallas, TX, USA) (SO); and Clinical Center for Multiple Sclerosis, Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA (GR). Kay Hartley is now with Providence Home Health, Portland, OR, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Costello
authors.affiliation: College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA (MLF); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Forget-Me-Not Home Memory Care, Raleigh, NC, USA) (JB); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Rush Multiple Sclerosis Center, Chicago, IL, USA) (RTB); Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA (KC); Acadia Neurology Center, Acadia, CA, USA (GCH); Providence Multiple Sclerosis Center, Providence St. Vincent Medical Center, Portland, OR, USA (KH); Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, OH, USA (MN); Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA (substantial portion of contributions made while employed at Texas Neurology, Dallas, TX, USA) (SO); and Clinical Center for Multiple Sclerosis, Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA (GR). Kay Hartley is now with Providence Home Health, Portland, OR, USA.
authors.forename: Gail C
authors.initials: GC
authors.lastname: Hartley
authors.affiliation: College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA (MLF); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Forget-Me-Not Home Memory Care, Raleigh, NC, USA) (JB); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Rush Multiple Sclerosis Center, Chicago, IL, USA) (RTB); Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA (KC); Acadia Neurology Center, Acadia, CA, USA (GCH); Providence Multiple Sclerosis Center, Providence St. Vincent Medical Center, Portland, OR, USA (KH); Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, OH, USA (MN); Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA (substantial portion of contributions made while employed at Texas Neurology, Dallas, TX, USA) (SO); and Clinical Center for Multiple Sclerosis, Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA (GR). Kay Hartley is now with Providence Home Health, Portland, OR, USA.
authors.forename: Kay
authors.initials: K
authors.lastname: Hartley
authors.affiliation: College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA (MLF); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Forget-Me-Not Home Memory Care, Raleigh, NC, USA) (JB); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Rush Multiple Sclerosis Center, Chicago, IL, USA) (RTB); Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA (KC); Acadia Neurology Center, Acadia, CA, USA (GCH); Providence Multiple Sclerosis Center, Providence St. Vincent Medical Center, Portland, OR, USA (KH); Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, OH, USA (MN); Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA (substantial portion of contributions made while employed at Texas Neurology, Dallas, TX, USA) (SO); and Clinical Center for Multiple Sclerosis, Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA (GR). Kay Hartley is now with Providence Home Health, Portland, OR, USA.
authors.forename: Marie
authors.initials: M
authors.lastname: Namey
authors.affiliation: College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA (MLF); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Forget-Me-Not Home Memory Care, Raleigh, NC, USA) (JB); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Rush Multiple Sclerosis Center, Chicago, IL, USA) (RTB); Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA (KC); Acadia Neurology Center, Acadia, CA, USA (GCH); Providence Multiple Sclerosis Center, Providence St. Vincent Medical Center, Portland, OR, USA (KH); Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, OH, USA (MN); Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA (substantial portion of contributions made while employed at Texas Neurology, Dallas, TX, USA) (SO); and Clinical Center for Multiple Sclerosis, Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA (GR). Kay Hartley is now with Providence Home Health, Portland, OR, USA.
authors.forename: Shirley
authors.initials: S
authors.lastname: O'Leary
authors.affiliation: College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA (MLF); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Forget-Me-Not Home Memory Care, Raleigh, NC, USA) (JB); Biogen Idec, Weston, MA, USA (substantial portion of contributions made while employed at Rush Multiple Sclerosis Center, Chicago, IL, USA) (RTB); Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA (KC); Acadia Neurology Center, Acadia, CA, USA (GCH); Providence Multiple Sclerosis Center, Providence St. Vincent Medical Center, Portland, OR, USA (KH); Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, OH, USA (MN); Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA (substantial portion of contributions made while employed at Texas Neurology, Dallas, TX, USA) (SO); and Clinical Center for Multiple Sclerosis, Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA (GR). Kay Hartley is now with Providence Home Health, Portland, OR, USA.
authors.forename: Gina
authors.initials: G
authors.lastname: Remington