护士对多发性硬化症干扰素治疗期间减轻类流感症状方法的看法。
Nurses' perspective on approaches to limit flu-like symptoms during interferon therapy for multiple sclerosis.
作者信息
Filipi Mary L, Beavin Jill, Brillante Raquel T, Costello Kathleen, Hartley Gail C, Hartley Kay, Namey Marie, O'Leary Shirley, Remington Gina
机构信息
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.
出版信息
Int J MS Care. 2014 Spring;16(1):55-60. doi: 10.7224/1537-2073.2013-006.
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.
背景
几种β-干扰素（IFNβ）制剂已被批准作为一线疾病改善疗法用于治疗多发性硬化症（MS）患者。全身注射后反应，通常称为流感样症状（FLS），在接受IFNβ治疗的所有患者中约有一半会出现，并且可能影响治疗依从性。这些症状包括发热、寒战、不适、肌痛和头痛，通常在每次注射后24小时内缓解或间歇性持续。由于FLS通常在治疗过程早期出现并随时间减轻，是导致不依从IFNβ治疗的主要原因，因此采用能够减轻这些副作用的策略非常重要。
方法
为了确定有效限制FLS的干预措施，召集了一组在美国具有MS患者护理专业知识的护士，并完成了文献综述。
结果
就可以减轻FLS的具体干预措施达成了专家小组共识。这些预防和缓解策略包括剂量滴定、镇痛和最佳注射时间，以及专家小组成员在其临床实践经验中发现有用的其他技术。
结论
这些措施，再加上有效的患者教育，将有助于降低IFNβ治疗继发的FLS发生率，提高患者用药依从性，并对长期临床结果产生积极影响。
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