Interferons and Multiple Sclerosis: Lessons from 25 Years of Clinical and Real-World Experience with Intramuscular Interferon Beta-1a (Avonex)

Abstract

Recombinant interferon (IFN) β-1b was approved by the US Food and Drug Administration as the first disease-modifying therapy (DMT) for multiple sclerosis (MS) in 1993. Since that time, clinical trials and real-world observational studies have demonstrated the effectiveness of IFN therapies. The pivotal intramuscular IFN β-1a phase III trial published in 1996 was the first to demonstrate that a DMT could reduce accumulation of sustained disability in MS. Patient adherence to treatment is higher with intramuscular IFN β-1a, given once weekly, than with subcutaneous formulations requiring multiple injections per week. Moreover, subcutaneous IFN β-1a is associated with an increased incidence of injection-site reactions and neutralizing antibodies compared with intramuscular administration. In recent years, revisions to MS diagnostic criteria have improved clinicians' ability to identify patients with MS and have promoted the use of magnetic resonance imaging (MRI) for diagnosis and disease monitoring. MRI studies show that treatment with IFN β-1a, relative to placebo, reduces T2 and gadolinium-enhancing lesions and gray matter atrophy. Since the approval of intramuscular IFN β-1a, a number of high-efficacy therapies have been approved for MS, though the benefit of these high-efficacy therapies should be balanced against the increased risk of serious adverse events associated with their long-term use. For some subpopulations of patients, including pregnant women, the safety profile of IFN β formulations may provide a particular benefit. In addition, the antiviral properties of IFNs may indicate potential therapeutic opportunities for IFN β in reducing the risk of viral infections such as COVID-19.

Fig. 1

Timeline of key developments in the history of interferon beta-1 (IFN β-1) for MS. CHAMPIONS Controlled High-Risk Avonex Multiple Sclerosis Prevention Study in Ongoing Neurological Surveillance, CHAMPS Controlled High Risk Avonex Multiple Sclerosis Study, FDA Food and Drug Administration, IFN interferon, IM intramuscular, IT intrathecal, MSCRG MS Collaborative Research Group, SC subcutaneous; ^aKrause and Petska (2005) [199]; ^bIsaacs et al. (1957) [34]; ^cJacobs et al. (1981, 1982) [44, 45]; ^dSC IFN β-1b (Betaseron^® and Extavia^®) (2020) [49, 51]; ^eJacobs et al. (1996) [78]; ^fIM IFN β-1a (Avonex^®) (2020) [52]; ^gJacobs et al. (2000) [79]; ^hSC IFN β-1a (Rebif^®) (2020) [53]; ⁱKinkel et al. (2012) [85]; ^jpegylated IFN β-1a (Plegridy^®) (2021) [54]; ^kCohan et al. (2018) [116]; Fox et al. (2013) [119]; Gajofatto et al. (2009) [195]; Einarson et al. (2017) [127]