Interferons and Liver Testing

[venice*]

Hoping Lady doesn't mind my using her post to start a new thread.
Considereing that so many of us with MS do take Interferons, I think this is so important it needs its own thread topic and I don't want to take away from condoleces to Leah's family.


I remember Leah was on Betaseron for about 14 years. I read this article recently, it discusses the Liver injury problem, so make sure you get your Liver tested.
A CMP (14) and CBC is very important. This may not have been her cause, but you never know.
Lady

Hepatic injury, liver monitoring and the beta-interferons for multiple sclerosis.

Tremlett H, Oger J.
Department of Medicine (Neurology) rm S159, Vancouver Hospital and Health Sciences Centre, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada. tremlett@interchange.ubc.ca

This review explores the salient issues surrounding liver injury and liver monitoring associated with beta-interferon (IFNB) treatment for multiple sclerosis (MS). Post-marketing studies have found a higher proportion of IFNB-treated MS patients with elevated aminotransferases than reported in the pivotal clinical trials.

Although the risk of severe liver injury appears small, the true incidence is unknown. Post-marketing studies have shown that the greatest period of risk for the development of liver test abnormalities appears to be in the first year of IFNB treatment. The risk also increases with the more frequently administered, higher-dosage IFNBs.

Males are more likely than females to develop elevated aminotransferases (> upper normal limit), although females appear at a greater risk of severe liver injury.

Of the commonly used biochemical liver tests, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AP) and bilirubin appear the most useful for routine monitoring of IFNB treatment.

Whilst many other factors can affect liver test results, including obesity, alcohol, concomitant medications, co-morbidities and theoretically even MS itself, regular liver testing both prior and during IFNB therapy might help minimise Type A or dose/frequency dependent aminotransferase elevations.

However, testing will probably not prevent the Type B idiosyncratic reactions which can result in severe hepatic injury; hence patients need to be aware, and to report hepatic side effects promptly.


PMID: 15592724 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/15592724?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=5&log$=relatedarticles&logdbfrom=pubmed

[venice*]

This if from the MAYO Clinic Site(you can go to the link for additional info about treatments):

http://www.mayoclinic.org/multiple-sclerosis/treatment.html

Medications to Treat MS

Beta Interferons

Interferon beta-1b (Betaseron) and interferon beta-1a (Avonex, Rebif) are genetically engineered copies of proteins that occur naturally in the body.

These medications reduce flare-ups of MS. It's uncertain which of their many actions lead to a reduction in disease activity and what their long-term benefits are.
Beta interferons should never be used in combination with one another.
Only one medication should be used at a time.

The U.S. Food and Drug Administration (FDA) has approved beta interferons only for people with relapsing forms of MS who can still walk.
Beta interferons don't reverse damage and haven't been proven to prevent permanent disability.

Some people develop antibodies to beta interferons, which may make them less effective. Other people can't tolerate the side effects, which may include symptoms similar to those of the flu (influenza).

Mayo Clinic neurologists generally recommend beta interferons for people who have more than one attack of MS a year and for those who don't recover well from flare-ups. The treatment may also be used for people who have a significant buildup of new lesions as seen on an MRI scan, even without major new symptoms of disease activity.

[NOT a beta Interferon]:
Glatiramer
This medication is an alternative to beta interferons if the patient has relapsing-remitting MS. Glatiramer shouldn't be used at the same time as beta interferons. Glatiramer is as effective as beta interferons in curbing MS attacks. Physicians believe that glatiramer blocks the immune system's attack on myelin. Glatiramer must be injected subcutaneously once daily. Side effects may include flushing and shortness of breath after injection.


Medications That Treat MS Symptoms …

[fahrmar]

Thanks Venice. A good post. I was on Rebif for 6 months, and my liver levels were double the high-end of normal. Given that Rebif made me so ill, on a daily basis, that I had no real quality of life, I refused to continue it.

I was being yo-yoed between my local neuro and a specialist, and after all that transpired for me with Rebif, I opted to maintain my treatment locally. The specialist actually wanted me to eye-ball discharging half the contents from the syringe, so I was injecting 22 mcg instead of 44 mcg. I did not feel comfortable with that as a viable option.

I began Copaxone two weeks ago.

[Cherie]

When my liver enzymes elevated (3-4x high normal) 4 years ago, my doc put me on Milk Thistle twice daily to protect the liver. Although they had been high for three years (not this high, though) they came back to normal range in just one month on this supplement. I have gone off it for a month or two at different times since and they elevate again so it seems my body needs the supplementation to safely stay on Interferons long term.

My doc monitors them every 2 months although the inserts with the meds recommend at least every 6 months. In fact, my neuro monitors LFTs (Liver Function Tests) monthly for the first 6 months on all patients that he prescribes an interferon for. I am surprised at how many folks on these meds that I've spoken with that only have blood tests annually. That, IMO, is downright dangerous.

I've also noted that site reactions are more prominent when my LFTs are elevated. Not sure if anyone else has noticed this.

[Howie]

I don't take any of the MS drugs, but do drink like a fish, and I take Milk Thistle to protect any damage I may be doing to my liver. Cheers! :cool:

[fahrmar]

When my liver enzymes elevated (3-4x high normal) 4 years ago, my doc put me on Milk Thistle twice daily to protect the liver. Although they had been high for three years (not this high, though) they came back to normal range in just one month on this supplement. I have gone off it for a month or two at different times since and they elevate again so it seems my body needs the supplementation to safely stay on Interferons long term.

My doc monitors them every 2 months although the inserts with the meds recommend at least every 6 months. In fact, my neuro monitors LFTs (Liver Function Tests) monthly for the first 6 months on all patients that he prescribes an interferon for. I am surprised at how many folks on these meds that I've spoken with that only have blood tests annually. That, IMO, is downright dangerous.

I've also noted that site reactions are more prominent when my LFTs are elevated. Not sure if anyone else has noticed this.

Cherie,
I was taking Milk Thistle daily, while on Rebif, and my LFT showed double high end normal levels. Rebif made me feel so ill, extreme fatigue, headaches, nausea and muscle cramps like I've never experienced before. It actually felt like somone had grabbed my muscle and was twisting it.

The third month on Rebif, I noted improvement across the board and I was very excited. But by the 4th month that was gone and I was terribly ill, and experiencing significant injection site reactions. So by month 6, still feeling so very ill every single day, terrible site reactions and elevated liver enzymes, I said, "No more." To this day, I still have a discolored area on my thigh from one of my last Rebif injections, 3 months ago. Scary business.

Decribing my experience to him, my neuro believes I had developed Nabs, although we did not test for that. Instead, I switched to Copaxone, and so far I'm having a very positive experience. (My specialist Rx'd the Rebif, and she's a 3 hour drive away. I will write to her soon thanking her for all she's done to help me, but that I intend to stay with my local neuo.)

Each of us is a unique critter biochemically! I am so glad that the interferons have been helpful for you, and for so many. At least we have something to help slow this beast, and I am very grateful for that.

Peace.

*butterfly2

[venice*]

When my liver enzymes elevated (3-4x high normal) 4 years ago, my doc put me on Milk Thistle twice daily to protect the liver. Although they had been high for three years (not this high, though) they came back to normal range in just one month on this supplement. I have gone off it for a month or two at different times since and they elevate again so it seems my body needs the supplementation to safely stay on Interferons long term.

My doc monitors them every 2 months although the inserts with the meds recommend at least every 6 months. In fact, my neuro monitors LFTs (Liver Function Tests) monthly for the first 6 months on all patients that he prescribes an interferon for. I am surprised at how many folks on these meds that I've spoken with that only have blood tests annually. That, IMO, is downright dangerous.

I've also noted that site reactions are more prominent when my LFTs are elevated. Not sure if anyone else has noticed this.


Hi Cherie,

I knew you took Milk Thistle and hoped you dropped a note here. I take it a precaution at a lower dose and really have no way of knowing if it helps (as I've luckily never had elevated LFTs)/ but given the risk benefit possiblities I feel good about taking it along with my avonex.

Hmmm, do you think if I increased my M.T. dose I could travel and climb mountains too!?;)


Each of us is a unique critter biochemically!

So True. Hope the Copaxone works for your biology Fahrmar!

[blossom4th]

venice,
I got a laugh from your postscript to Cherie about increasing your dose of Milk Thistle so you can climb mountains! :p It is supposed to increase your energy as your liver health is restored and other parts of your system are helped.I've been reading up on it,and decided to add it to my regimen. It aids the blood circulation,digestion & elimination of wastes (increases production of bile) balance hormones and even clear up skin conditions.

[Cherie]

Blossom,
I think Venice was referring to my trip to India in January and to a small mountainous trail I was able to climb for the first time in 15+ years last fall. I don't think it has to do with Milk Thistle but I do think it has to do with being in better physical and nutritional health overall with the changes I've made over the past few years.