Sunday, 5 July 2015

Rebismart is OK

Bayas A, Ouallet JC, Kallmann B, Hupperts R, Fulda U, Marhardt K; SMART study group. Adherence to, and effectiveness of, subcutaneous interferon β-1a administered by RebiSmart® in patients with relapsing multiple sclerosis: results of the 1-year, observational SMART study. Expert Opin Drug Deliv. 2015 22:1-12. [Epub ahead of print]


BACKGROUND:Patients with multiple sclerosis who have poor adherence to treatment have a higher risk of relapse than adherent patients. This study assessed adherence to, and effectiveness and convenience of, treatment with subcutaneous (sc) interferon (IFN) β-1a (Rebif®, Merck Serono SA) 44 or 22 μg three times weekly in patients with relapsing multiple sclerosis (RMS) using the RebiSmart® electronic, multidose, autoinjector for 1 year.
STUDY DESIGN:European, multicentre, observational study among neurologists: inclusion criteria included RMS, Expanded Disability Status Scale score ≤ 6, sc IFN β-1a administered by RebiSmart for ≤ 6 weeks. The primary endpoint was cumulative adherence recorded by RebiSmart.
RESULTS: The safety population included 912 patients, 77.4% (n = 823) of whom completed the Month-12 visit. Mean (± standard deviation) cumulative adherence was 97.1 ± 7.3% (n = 791). The most common reason for missed injection was 'forgot to inject' (37.0%). At Month 12/ED, 79.5% of patients were relapse-free. Of 353 patients who rated the convenience of the device, 68.3% found injecting 'very easy'. No unknown safety issues were detected.
CONCLUSIONS: Patients with RMS self-injecting sc IFN β-1a with RebiSmart had excellent adherence at Month 12/ED, which was associated with good clinical outcomes and no unexpected safety issues. Patients rated RebiSmart as convenient and easy to use.

Self-injectors are welcomed as we all know but we have to ensure that these first line DMT are working and that NEDA is being achieved. Without this maybe time to ditch the self injectors and move onto an tablet or infusion

CoI None

2 comments:

  1. If NEDA includes atrophy (& it should, due to its strong correlation with long term disability), then certainly the CRAB drugs & probably even the orals shouldn't be seriously considered. If NEDA is the goal, why aren't induction treatments (Lemtrada, CD 20's, Cladribine, etc) & HSCT seriously considered as a first option?

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  2. I found the RebiSmart a good little device, and very easy to use, although a bit heavy for reaching some injections sites e.g. back of hips (I never injected into the backs of my arms as it was too awkward to reach that site). It was easier and simpler than the dial-up injector, which tended to inject a bit too fast thus causing some pain/discomfort. I did have some problems with hand tremors make hip injections a bit awkward - i.e. holding the machine still long enough to wait for the "injection complete" beeps. The worst problems I had were with Rebif itself, with endless ongoing side effects which did not diminish "over time" as the manufacturers claim will happen for "most people". If you are stuck with Rebif as your drug then this is a good device.

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