Multiple Sclerosis

This past week, my brother in law was diagnosed with MS and the family is looking to me for advice for his treatment. Of course, as a soon-to-be med student, I actually know nothing.
All that aside, I could use some feedback from those of you who have dealt with MS either personally or professionally. Here's the immediate decision to be made: which medication to take (of these 4 choices)
1.Avonex: beta interferon 1-a; weekly IM injection
2. Rebif: beta interferon 1-a; daily sub-q injection
3. Betaseron: beta interferon 1-b; daily sub-q injection
4. copaxone: glatiramer acetate; daily sub-q injection; non-interferon…may act as a myelin decoy
The neurologist my brother in law is seeing said she couldn't recommend any one over the others. He is also currently taking steroids.
Any input would be most appreciated.

For what it is worth, since I know only how to operate a moist towelette at this point, here is a site that I found regarding all except Copaxone.…_92.asp
A friend of mine is taking AVONEX weekly. He has had great success with this for over 2 years now. I hope your brother-in-law responds favorable to his treatment. The side effect that he has is flue like symptoms each time he takes an injection. He pre-medicates with Tylenol a few hours before he takes the injection to mediate the symptoms. My friend offered more information if your brother-in-law is interested.
From what I found Copaxone hasn’t had pharmacokinetic studies done in humans only in animal trials.

Just my $.02 worth. . .
My brother was diagnosed with MS a little over a year ago. He is currently on Avonex, and seems to be doing very well with it. A friend of mine at work also has MS, and has been on Avonex for about 5 years. She was totally unable to work when she began, but has been able to come back to work full time for about the last 2 or 3 years now. With these two people both seeing improvement and more time between flares, I feel Avonex is a smart choice!

Thank you so much–I truly appreciate your input! I was leaning towards Avonex based on what I had read about all 4 meds.
Does anyone know if Avonex and Copaxone are ever administered together? I haven't found anything suggesting this, but since they work (or appear to work) differently it seems like a reasonable suggestion to me. (of course, as I said earlier, I know nothing)

I am not a neurologist, but I have patients doing well on Avonex and copaxone. I recommend that your loved one get a second opinion. It may be worth travelling to an academic medical center to consult with someone who specializes in MS treatment. Many academic medical centers will have such a neurologist, and a true expert in MS treatment will be able to provide information that will help greatly in this tough decision.

Thanks for the drug combo info.
I have already recommended that he get a 2nd opinion. I’m not sure he’ll follow through though: they (he & his wife) live a few hours away from any major city/medical center and they don’t have the $ to travel any distance or to be able to take off of work.
Right now we’re encouraging him to move closer to us…for better access to medical care and assistance from us if he becomes debilitated.
I truly appreciate everyone’s help!

Dang, I go on vacation and so missed this thread when it started… HERE’s a topic I can say a lot about! I was diagnosed with MS four years ago and have been taking Avonex ever since. My reason for choosing Avonex: convenience. I didn’t want to have to screw around with injections more than once a week. I had the typical flu-like reaction to each injection in the early weeks of treatment, but it subsided (as was predicted). Over the first two years or so, I occasionally forgot to co-medicate with Advil and would wake up aching and feverish, then groan and realize my mistake. This happened sufficient number of times that I now am conditioned NOT to make such a mistake again.
There are studies ongoing that are looking at combining an interferon (ie., Avonex, Betaseron, Rebif) with glatiramer acetate (Copaxone). I am pretty sure that it would not be possible to get such a medication regimen covered by insurance, because I don’t think there’s any data yet to support the combination. (each of these drugs is ~$1000/month!)
Each manufacturer will of course claim that its medication is better in some subtle way. The truth is that there isn’t anything that argues strongly for one medication versus another in this particular case, and so it is perfectly reasonable to make a choice based on personal preference. The husband of a friend of mine chose Betaseron because he was intimidated by the “big needle” of Avonex. (It’s a 1-1/4" 23-gauge intramuscular injection; Betaseron, Rebif and Copaxone are all 27-gauge subcutaneous injections, much shorter needles like those used for insulin injections)
You say:
Right now we’re encouraging him to move closer to us…for better access to medical care and assistance from us if he becomes debilitated.
If I may gently disagree with this point of view. MS is a chronic illness that can greatly change one’s life. But to start out thinking that it will change your life in all sorts of drastic ways is, IMHO, counterproductive. I would recommend that you support him to incorporate MS into the life he has established, rather than letting MS be the determinant of what he does from here on out. Many people with MS continue to be gainfully employed, able to get around on their own, functioning with adjustments and limitations that aren’t necessarily career- or life-altering. (some of us with MS are in medical school! :D) The stereotype of MS is that you will eventually be in a wheelchair; in fact, half of people with MS do not regularly need an assistive device for getting around, and 75% will never regularly use a wheelchair.
The flip side of those assumptions is the assumption that someone who is not experiencing an exacerbation of their MS must not be having any disease activity. This is not true, unfortunately, and although MS is viewed as “episodic” in most people, the truth is that its progress is ongoing even in people with “relapsing-remitting” MS. This is why it is SO IMPORTANT for people to begin therapy with one of these treatments, because all of them are shown to reduce the progression of disease.
The National MS Society ( is wonderful, and I strongly urge everyone in your family to check out their resources. They’ve got tons of information on their website. They also have local chapters that provide meetings, support, etc. etc. You’ll note lots of fundraising info on their website and in the materials from local chapters - don’t be turned off. NMSS is a major player in supporting the research for MS that has led to these new, hopeful treatments.
Okay, it’s a fictional character, but if you’d like to see an inspiring portrayal of someone with MS, the President on “The West Wing” has MS - this was the big plot twist in last year’s shows (and the reason I started watching!). Note he manages to continue to run the country, walk around the White House, etc. etc. NMSS has served as a major consultant to the show.
The uncertainty of MS is so very scary. Although I feel great today, I know that I could get dizzy tomorrow and find myself unable to walk by day’s end - it’s happened before. But I will tell you that I have been relapse-free since I started Avonex and I continue to presume that I will be able to get around for the foreseeable future. All the best to your brother-in-law!

Thanks, Mary.
My brother in law has decided on Avonex. I’m not sure when he will begin his treatment.
I do understand that many with MS are not debilitated at any point in their disease. The problem in this case is that he and his wife have absolutely no support system where they live now (neither family or close friends). Unfortunately, that leaves them high and dry if there ever is a problem. He has been told that it looks like he has a less agressive type of MS, so hopefully he will continue to do well.
Again, I appreciate everyone’s input. It has been truly helpful. :)