This patient being treated with an interferon beta preparation should have her serum aminotransferase levels measured every 3 to 6 months. Interferon injections are associated with rare autoimmune hepatitis. Therefore, monitoring of liver status by periodic measurement of serum aminotransferase levels is appropriate in patients with multiple sclerosis (MS) who take an interferon beta preparation as a disease-modifying therapy. Although the optimal frequency of monitoring has not been established, most cases of severe hepatotoxicity appear to occur early in therapy. It is also recommended that concurrent use of potentially hepatotoxic agents, such as alcohol, be avoided while taking interferon therapy. Other more common adverse effects include injection site reactions, flu-like symptoms, and depression.
JC virus antibody screening is currently recommended as a risk mitigation strategy for patients with MS treated with natalizumab because elevated levels of JC virus antibody have been correlated with an increased risk of progressive multifocal leukoencephalopathy (PML) in patients taking this drug. However, no incidences of PML have been reported in patients (such as this one) treated with interferon beta injections. Therefore, monitoring for JC virus antibody is not indicated.
Frequent ophthalmologic examinations are recommended for patients taking fingolimod for MS because of the risk of macular edema. No specific ocular risks are associated with interferon injections.
Teriflunomide has been associated with pancreatitis, and monitoring of the serum amylase and lipase levels is indicated for patients with MS who take this medication. Interferon beta preparations have not been associated with this adverse effect.