Rebif affecting bloodwork

[EileenB]

Hello everyone...haven't posted in awhile. Quick recap diagnosed RR in 2006. Avonex for 6 months then switch
to copaxone after I developed depression on Avonex. On
Copaxone until oct 2010 when I had a flare and MRI showed increase in number and size of lesions. Neuro and I decided to try Rebif, but since I was scheduled for same day surgery to relieve pressure off nerve in my neck, we decided to wait until after surgery and recovery to start new med.

Had the surgery mid-Nov and woke in recovery room paralyzed on right side. High dose steroids and excellent care at hospital and rehabilitation hospital got me back to point where I could bear weight on R leg and regained some use of R hand. Home by Christmas, albeit with a wheelchair as I still couldn't bear weight. Finally started to taper off high dose steroids in Feb....started Rebif in March, 1st on titration pack then 22mcg then 44mcg.

Had a couple UTI's over the summer, and another flare in May that was treated with IV steroids, and this time they did not seem to relieve the symptoms as they had in the past. Also noticed June/July that I was running low grade fevers, and since Jan had lost about 30 pounds.
Fast forward to last week saw Infectious Disease specialist who did lots of bloodwork and initial results that are back show WBC of 3.0, RBC 3.9 and Platelets 170. These are quite different from labs done in march when I had the first UTI....

So....I know Rebif can impact Liver function tests...can it also impact CBC and chemistry values? If I stop the Rebif how long before I would expect to see improvement in blood counts...? With these symptoms the differential includes things like Leukemia and Lymphoma....but if it is the Rebif then that leaves Tysabri as the next recommended medication and I am very cautious about starting that.

any insight advice would be welcome. have appt with neuro later this week...

[Redwings]

From drugs.com, the adverse effects of Rebif include:
leukopenia (36%); lymphadenopathy (12%); thrombocytopenia (8%); anemia (5%).

Your platelets are good, and your RBC count isn't too bad (my last count was 3.73 and my doctor doesn't care because other tests are good), but your white count is low. There are a few situations where some doctors will accept a count that low, but the circumstances are different than yours. For example, the condition is more serious than MS (such as lupus or cancer), or the drug offers better effectivity for that kind of risk (such as Gilenya over Rebif). (My doc was OK with my WBC being 3.5, but when it hit 2.4, that was too low.) But with your UTIs and fever and weight loss, it doesn't sound like that fits your situation.

I don't have an exact answer for how long it will take your cell counts to rebound. If Rebif is the cause and you discontinue it, your cell counts should come up in just a few weeks. It took about two months for my white cell count to come back up to the normal range, but I had only cut my dose in half -- I didn't stop the med altogether.

One of the unknowns is what might happen if you switch to Betaseron. (It's a little surprising that your doc suggested Rebif, since it's the same med as Avonex, which caused your depression.) Betaseron is a slightly different interferon, so might not cause the problems with your cell counts. But it's still an interferon, so might cause depression (even though Rebif somehow didn't). But since you're hesitant to try Tysabri, and Gilenya works by dropping white cell count, Betaseron much be worth trying first. Even if it doesn't agree with you, you'll know you tried your last option before moving on to Tysabri.

[wkikta]

Surprisingly, many people who had trouble with Avonex and Rebif have had very good results with Betaseron. Since you are so uncomfortable with Tysabri, I say try the Betaseron.

[EileenB]

Thanks for the replies and feedback. Have not taken Rebif since last Friday. MS Lifelines nurse said that
Rebif stays in your system for two weeks. So I am 6
days with no interferon, still have fever and new areas
of bruises, small red spots like blood blister under the
skin. This time I will take pictures of them to show the
Infectious Disease doc....

thanks again
EileenB

[EileenB]

Soo.......off Rebif since Sept 2, saw an initial bounce up in bloodwork (WBC 5.9), however repeat done where I
work shows WBC stable, but RBC 3.8, Platelets down to 127, RDW down to 4% from 6%. CA 2.8 and a couple others off. Temps 99.6. Lost 8 pounds I gained on vacation in about a week.....

And saw neuro this past monday due to increase in leg weakness and balance issues. Flare....started 1GM solumedrol today, doses friday and saturday. Had CBC, Chemistry, Metabolic Panel and PTINR run yesterday before start of steroids. Should have those results by Monday hopefully.

Question is how long will the impact of the steroids on the bone marrow last.....will I need to reschedule an appointment with Hematology/Oncology for review and bone marrow biopsy next week? Left message for neuro but thought i would throw it out here in case anyone knows...thanks guys

Eileenb

[Redwings]

Question is how long will the impact of the steroids on the bone marrow last?

Hi Eileen:
I don't know the answer to that one. The half-life of methylprednisolone is 18 to 36 hours, so (in theory) the IVSM will metabolize and be out of your body about 3 to 4 days after your last dose. But how fast your bone marrow will return to baseline, I don't know. That's a great question for your hematologist.

...will I need to reschedule an appointment with Hematology/Oncology for review and bone marrow biopsy next week?

That's another great question to ask the hematologist. It seems reasonable that the doctor would want a biopsy done under normal conditions, not when steroids have (or may have) affected your status.