How do I decide?

[seshultz62]

I have been taking Rebif since last October. My liver numbers are up so I have to change. I wanted to try an oral but my insurance says NO! I have to try at least 3 injectables before they will cover an oral. Anyway, I am reading about Avonex and copaxone. How do I decide? How often do you take them? Rebif was 3 times a week. The medicine was very painful. Could handle the small needle, though. Worried the needles for Avonex and Copaxone will be bigger? Sounds wimpy, I know, but have always hated needles. Can't believe I was giving myself shots. I even thought about NOT going on any medicine. I'm more afraid of my memory and cognitive issues getting worse than anything else, though. Is Avonex and Copaxone medicines painful like rebif? Oh, I just hate I have to start over. Was just beginning to feel comfortable with med and nurses. My nurse was so helpful, plus I was on co-pay plan and that was a blessing. Would sure appreciate any helpful advice.

[Alicious]

I'd do Copaxone, personally. The needle is small and it's subcutaneous just like Rebif, but it doesn't have liver/thyroid/depression in the side effect profile. It's once a day, but it has none of the flu like side effects.

In the minute or so after injecting it does burn a bit. It's not horrible, but it's there, and then I had an itchy lump (like a large mosquito bite) for a few days. You can ice it and heat it and it helps. It's not fun, but it's still better than the flu like side effects of an interferon.

As for Avonex, the needle is longer because it goes into the muscle, but *it actually hurts less.* Why? No idea. Avonex is the same med as Rebif, though, just delivered into the muscle instead of subcutaneously, so if your liver numbers are off on Rebif it's worth asking your doctor if Avonex is really a safe bet. It's a once a week med, and maybe that is the difference, but again, worth asking.

If I were you, I'd go on Copaxone and see how that goes, and give your liver a break for awhile. I've been on all three, and Copaxone, even though it was daily, was by far my favorite. I'm not you though, so you need to do what works best for you. This is my advice, though.

[BigA]

These days, it's very very easy to inject with Avonex. The pen has a very short needle and you're no longer obliged to push a long nail into your leg. So from the injection perspective, avonex is now the easiest (IMO) of all the shots because it's only once per week, you don't see the needle and it's over in a second, doesn't hurt and site reactions are the rarest of all the injectables.

The only problem is that it's the exact same medicine as Rebif, so you may have the same problems. However, it's a much lower dosage. Rebif is 44mcg 3x weekly, where Avonex is 30mcg 1x weekly. I don't know how it works in the body, but that's 1/4 of the medication. The effectiveness is similar, so if rebif worked for you but your liver objected, ask your Dr. About Avonex. You can get a free month as well.

[MSer102]

I don't know how it works in the body, but that's 1/4 of the medication.

Avonex goes into a muscle and is released slowly over the course of a week so that's why the dose is lower and it's only injected once a week. Rebif goes under the skin and is absorbed and used by the body more quickly so the dose is higher and it has to be injected twice as often.

When I was on Avonex there wasn't an autoinjector and it was with the larger needle. I found it to be practically painless. No injection site reactions ever and it didn't sting.
As mentioned before Avonex is the same medicine as Rebif. It won't be like starting over because you are already used to the medicine. But your liver enzymes might still be elevated. But if your insurance requires you to try two more injectibles you could try Avonex because you already know what it feels like to be on that medicine.

The needle for Copaxone is little and is the same size as for Rebif. Copaxone also stings a lot and I think more than for Rebif. Since you are already used to shallow injections with a small needle with a medicine that stings and causes injection site reactions you could try Copaxone next. In that respect it won't be like starting over. It isn't known to cause liver problems so I think your enzymes will most likely come down. It has the same effectiveness as Rebif and Avonex so if you do OK with the injections and if it works for you you might decide to stay on it.