Rebif (interferon beta-1a)

What is Rebif?

Rebif is a brand-name prescription medication. It’s approved for use in adults with certain forms of multiple sclerosis (MS). Specifically, Rebif is approved to treat the following conditions:

• Relapsing-remitting MS. With relapsing-remitting MS, you have periods of time with either few MS symptoms or no MS symptoms, followed by periods of relapse. (With relapse, you have new or worsened MS symptoms.)
• Active secondary progressive MS. With active secondary progressive MS, your MS steadily gets worse over time. But with this form of MS, you don’t have periods of relapse.
• Clinically isolated syndrome (CIS). CIS isn’t technically a form of MS. Instead, with CIS, you have an episode of MS-like symptoms that lasts at least 24 hours. CIS may or may not develop into MS.

Active ingredient and form

Rebif contains the active drug interferon beta-1a, which is a protein found naturally in your body. Because it’s made from living cells, Rebif is called a biologic drug. It’s not known for sure how Rebif works to treat MS.

Rebif comes as a liquid solution. It’s available in single-dose, prefilled syringes. (These syringes can be used with an optional autoinjector device to help make administering your injections easier.) Rebif is also available in single-dose, prefilled devices called Rebif Rebidose autoinjectors.

Both Rebif prefilled syringes and Rebif Rebidose autoinjectors come in the following strengths:

• 8.8 micrograms (mcg) per 0.2 milliliters (mL)
• 22 mcg per 0.5 mL
• 44 mcg per 0.5 mL

Rebif is given by subcutaneous injection (an injection under your skin). It’s taken three times each week. Your doctor will show you how to administer Rebif injections to yourself. For more information about the different forms of Rebif and how each one is taken, see the section below called “How to take Rebif.”

Effectiveness

In clinical studies, Rebif was effective in treating the conditions listed above. For information about Rebif’s effectiveness, see the section below called “Rebif for MS.”

Rebif generic or biosimilar

Rebif contains the active drug interferon beta-1a, which is a protein made by living cells. Because it’s made from living cells, Rebif is called a biologic drug.

Rebif is available only as a brand-name medication. It’s not currently available in biosimilar form.

A biosimilar drug is a medication that’s similar to a brand-name biologic drug. A generic drug, on the other hand, is an exact copy of the active drug in a brand-name medication that’s made from chemicals. But because biologic drugs are made from living cells, it’s not possible to copy these drugs exactly.

Rebif side effects

Rebif can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Rebif. These lists do not include all possible side effects.

For more information on the possible side effects of Rebif, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to report to the FDA a side effect you’ve had with Rebif, you can do so through MedWatch.

How long do side effects of Rebif last?

The most common side effects of Rebif are flu-like symptoms, such as muscle aches, tiredness, fever, and chills. For most people, these side effects either get better or go away over time. But exactly how quickly the side effects go away is different for each person using the drug.

If you have questions about how long you may have certain side effects from Rebif, talk with your doctor.

And for more information about the flu-like symptoms caused by Rebif, see the section below called “Side effect details.”

Mild side effects

Mild side effects of Rebif can include:*

• flu-like symptoms, such as muscle aches, headaches, tiredness, fever, and chills
• belly pain
• changes in certain blood tests that check your liver function
• injection site reactions
• fatigue (lack of energy)
• fever

Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

* This is a partial list of mild side effects from Rebif. To learn about other mild side effects, talk with your doctor or pharmacist, or see Rebif’s medication guide.

Serious side effects

Serious side effects from Rebif aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

• Changes in the level of your blood cells, such as decreased levels of white blood cells, red blood cells, or platelets. Symptoms will vary depending on the blood cells that are affected, but they can include:
  • bleeding or bruising more easily than usual
  • increased risk of infection
• Seizures. Symptoms can include:
  • loss of consciousness
  • shaking or trembling
  • rapid eye movements
• Thrombotic microangiopathy, which is a rare but serious side effect of Rebif. This condition can lead to life threatening blood clots in your small blood vessels. Symptoms can include:
  • fatigue (lack of energy)
  • bruising more easily than usual
  • excessive bleeding from small cuts or wounds, such as a paper cut
  • nosebleeds
  • confusion
  • urinating less than usual

Other serious side effects, which are explained in more detail in the “Side effect details” section below, include:

• allergic reaction
• severe injection site reactions
• liver effects, including liver damage
• depression or thoughts of suicide

Side effect details

You may wonder how often certain side effects occur with this drug. Here’s some detail on some of the side effects this drug may cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Rebif. Symptoms of a mild allergic reaction can include:

• rash
• itchiness
• flushing (warmth and redness in your skin)

In clinical studies, about 4% to 5% of people had a rash that’s sometimes related to allergic reactions to drugs. In comparison, 2% of people who took a placebo (treatment with no active drug) had this type of rash. It’s not possible to say for sure if Rebif caused this rash. But it’s possible that for some people, their skin rash was caused by a mild allergic reaction to Rebif.

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

• swelling under your skin, typically in your eyelids, lips, hands, or feet
• swelling of your tongue, mouth, or throat
• trouble breathing

There have been reports of people having severe allergic reactions called anaphylaxis after taking Rebif. But it’s not known how common this type of allergic reaction is.

Keep in mind that even if you’ve been taking Rebif for a long time, it’s still possible to have an allergic reaction to the drug.

Call your doctor right away if you have an allergic reaction to Rebif. But call 911 if your symptoms feel life threatening or you think you’re having a medical emergency.

Injection site reactions, such as pain or necrosis

You may have reactions at your Rebif injection sites. These reactions can include pain and skin necrosis (death of skin cells). In Rebif’s clinical studies, injection site reactions ranged from pain, redness, and swelling to infection and abscesses (open wounds).

In clinical studies, 89% to 92% of people who used Rebif had some type of injection site reaction. (This percentage varied depending on the dose of the drug they used.) And 39% of people who used a placebo (treatment with no active drug) had an injection site reaction.

In rare cases, people had skin necrosis at their injection site. For example, 1% of people taking 22 mcg of Rebif had skin necrosis. And 3% of people taking 44 mcg of Rebif had the same outcome.

In addition, in a study that compared Rebif with Avonex (another multiple sclerosis [MS] drug), injection site reactions occurred in:

• 28% of people who used Avonex
• 83% of people who used Rebif

While using Rebif, if you have areas of skin that are red, swollen, or bruised, call your doctor right away. They’ll recommended treatment if needed. And don’t inject Rebif into those areas until your doctor advises that you should.

How to prevent injection site infections and skin necrosis

While using Rebif, it’s important to take certain steps to reduce your risk of injection site infections and skin necrosis. These steps include:

• washing your hands before giving yourself each injection
• cleaning the area on your skin where you’ll be injecting the drug
• rotating your injection sites to different areas of your body
• never using a Rebif syringe or single-dose autoinjector for more than one injection

Liver effects

Liver effects, including liver damage, have been reported in people taking Rebif. In fact, changes in blood levels of liver enzymes are a common side effect of the drug. (Liver enzymes are certain types of proteins made by your liver.) And in some cases, increased enzymes can be a sign of liver damage.

Before and during Rebif treatment, your doctor may order blood tests to measure your liver enzyme levels. This allows your doctor to monitor the health of your liver and to make sure it’s safe for you to take Rebif.

Liver effects caused by Rebif can sometimes be serious. Because of this, it’s important to tell your doctor about any symptoms of liver problems you have while you’re taking the drug. Symptoms of liver damage may include:

• nausea
• loss of appetite
• feeling tired
• dark urine or pale stools
• yellowing of your skin or the whites of your eyes
• excessive bleeding
• confusion

If you have any of these symptoms, call your doctor right away. They’ll determine whether or not you need medical attention.

How common are liver effects with Rebif?

In clinical studies, high levels of certain liver enzymes occurred in more people taking Rebif than in people taking a placebo. (A placebo is a treatment with no active drug.) And more people taking Rebif had higher bilirubin levels than people taking the placebo. (High blood bilirubin levels may be a sign of liver damage.)

For example, of those taking Rebif:

• 20% to 27% of people had an elevated ALT* level. And 10% to 17% of people taking the drug had an elevated AST* level. (These percentages varied depending on the dose of Rebif used.) Of people taking a placebo, 4% had an elevated ALT level and 4% had an elevated AST level.
• 2% to 3% of people had an increased bilirubin** level. (This percentage varied depending on the dose of Rebif used.) Of people taking the placebo, 1% had an increased bilirubin level.

* Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are enzymes (types of proteins) that are made in your liver.

** Bilirubin is a protein that’s made when your liver breaks down red blood cells.

In rare cases, people who took Rebif required a liver transplant because of liver failure. But it wasn’t reported how often this occurred during clinical studies.

Flu-like symptoms

You may have flu-like symptoms while taking Rebif. In fact, flu-like symptoms are the most common side effects of Rebif.

Flu-like symptoms caused by Rebif may include:

• muscle aches
• fever or chills
• tiredness
• headache

In clinical studies, 56% to 59% of people taking Rebif had flu-like symptoms. (This percentage varied depending on the dose of Rebif used.) In comparison, 51% of people taking a placebo (treatment with no active drug) had flu-like symptoms.

If you have flu-like symptoms while taking Rebif, talk with your doctor. They may recommend that you take over-the-counter pain or fever-reducing medications. These medications could include acetaminophen (Tylenol) or ibuprofen (Motrin). Both of these drugs may help reduce your flu-like symptoms.

For most people, flu-like symptoms caused by Rebif either get better or go away over time. But exactly how long the symptoms last will be different for each person using Rebif.

Keep in mind that you may have an increased risk of infections while using Rebif. So, if you have flu-like symptoms that are severe or don’t get better, call your doctor. They can check to make sure that you don’t have an infection, such as the flu.

Depression or thoughts of suicide

It’s possible to have mood changes while you’re taking Rebif. These changes may include having depression or thoughts of hurting yourself or attempting suicide. It’s not known for sure how often these mood changes occur in people taking the drug.

If you’ve had depression in the past, you have a higher risk of developing this side effect with Rebif. And keep in mind that depression is common in people with multiple sclerosis (MS), which Rebif is used to treat.

If you have feelings of hopelessness or depression, talk with your doctor as soon as possible. And if you have thoughts of hurting yourself or attempting suicide, call your doctor or 911 right away.

Weight loss or weight gain

Changes in weight, such as weight gain or weight loss, haven’t been reported as common side effects of Rebif. However, weight changes may be a sign of liver damage, which is a possible side effect of Rebif.

If you notice changes in your body weight while taking Rebif, talk with your doctor right away. They can check to see if your weight change is due to a condition that needs medical attention.

Rebif for MS

The Food and Drug Administration (FDA) approves prescription drugs such as Rebif to treat certain conditions. Rebif may also be used off-label for other conditions. (Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.)

Rebif is FDA-approved for use in adults with certain forms of multiple sclerosis (MS). Specifically, Rebif is approved to treat the following conditions:

• Relapsing-remitting MS. With relapsing-remitting MS, you have periods of time with either few MS symptoms or no MS symptoms, followed by periods of relapse. (With relapse, you have new or worsened MS symptoms.)
• Active secondary progressive MS. With active secondary progressive MS, your MS steadily gets worse over time. But with this form of MS, you don’t have periods of relapse.
• Clinically isolated syndrome (CIS). CIS isn’t technically a form of MS. Instead, with CIS, you have an episode of MS-like symptoms that lasts at least 24 hours. CIS may or may not develop into MS.

With MS, your immune system attacks the protective covering, called the myelin sheath, around your nerve cells. This damage reduces communication between your brain and the nerves in the rest of your body.

It’s not known for sure what causes MS to develop. But some people think it’s caused by some sort of infection that triggers your immune system to overreact.

Over time, MS leads to lesions (areas of damage) in your brain and spinal cord. The condition can also cause certain disabilities, such as having trouble walking or balancing.

Rebif contains the active drug interferon beta-1a, which is a protein that occurs naturally in your body. It’s not known exactly how Rebif works to treat MS. But in clinical studies, the drug reduced MS symptom relapses and delayed disability caused by MS.

Effectiveness for MS

In clinical studies, Rebif was effective in treating MS. Below, we describe two studies that looked at using this drug in people with MS.

Rebif compared with a placebo

In a 2-year clinical study, Rebif treatment was compared with that of a placebo (treatment with no active drug). In order to participate in the study, people had to have had an MS flare-up at least twice over the past 2 years.

This study showed that:

• People who took Rebif had 32% fewer MS relapses during the study than they’d had in the past 2 years before the study. In comparison, people who took a placebo didn’t have a decrease in their number of MS relapses.
• People who took Rebif had an average of 1.73 to 1.82 MS relapses. In comparison, people taking the placebo had an average of 2.56 MS relapses.
• Depending on the dose of Rebif used, 25% to 32% of people who took Rebif were MS flare-free after 2 years. In comparison, only 15% of people who took a placebo were MS flare-free after 2 years.

In addition, people who took Rebif had fewer brain or spinal cord lesions on MRI scans than people who took the placebo. (MRI scans are imaging tests used to check for brain or spinal cord lesions in people with MS. And lesions on the brain or spinal cord indicate areas of damage.)

For example, the study found that:

• People who took 22 mcg of Rebif had an average of 0.75 lesions.
• People who took 44 mcg of Rebif had an average of 0.5 lesions.
• People who took a placebo had an average of 2.25 lesions.

Rebif compared with Avonex

In a 1-year clinical study, Rebif treatment was compared with Avonex treatment. (Avonex is another medication used to treat MS.) In this study:

• 75% of people who took Rebif were relapse-free at 24 weeks. In comparison, 63% of people who took Avonex had the same result.
• People who took Rebif had fewer brain or spinal cord lesions on MRI scans than people who took Avonex. For example, 50% of people who took 44 mcg of Rebif weekly had an average of 0.17 lesions on each of their MRI scans. In comparison, 50% of people who took Avonex had an average of 0.33 lesions on each of their MRI scans.

Rebif and children

Rebif hasn’t been studied for use in children. So, it’s not known if the drug is safe or effective for use in people younger than 18 years of age.

Rebif use with other drugs

Your doctor may recommend that you take certain other drugs before injecting your doses of Rebif. Doing this may help reduce some of Rebif’s side effects, such as flu-like symptoms. (Flu-like symptoms caused by Rebif may include fevers, chills, and muscle aches. They may also include tiredness and headaches.)

To help reduce flu-like symptoms, your doctor may recommend that you take an over-the-counter pain or fever-reducing medication. These medications include acetaminophen (Tylenol) and ibuprofen (Motrin).

If you’d like to know more about using these other medications with Rebif, talk with your doctor.

Alternatives to Rebif

Other drugs are available that can treat multiple sclerosis (MS), as well as clinically isolated syndrome (CIS). (CIS is a condition that causes MS-like symptoms.)

Some medications may be a better fit for you than others. If you’re interested in finding an alternative to Rebif, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed below are used off-label to treat these specific conditions. (Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.)

Examples of other drugs that may be used to treat MS or CIS include:

• interferon beta-1a (Avonex)
• glatiramer acetate (Copaxone)
• ocrelizumab (Ocrevus)
• teriflunomide (Aubagio)
• interferon beta-1b (Betaseron)
• interferon beta-1b (Extavia)
• cladribine (Mavenclad)
• siponimod (Mayzent)
• fingolimod (Gilenya)
• peginterferon beta-1a (Plegridy)

Rebif vs. Avonex

You may wonder how Rebif compares with other medications prescribed for similar uses. Here, we look at how Rebif and Avonex are alike and different.

Ingredients

Both Rebif and Avonex contain the same active drug: interferon beta-1a. This drug is a type of protein that occurs naturally in your body.

Uses

Rebif and Avonex are both approved for use in adults with certain forms of multiple sclerosis (MS). Specifically, these drugs are approved to treat the following conditions:

• Relapsing-remitting MS. With relapsing-remitting MS, you have periods of time with either few MS symptoms or no MS symptoms, followed by periods of relapse. (With relapse, you have new or worsened MS symptoms.)
• Active secondary progressive MS. With active secondary progressive MS, your MS steadily gets worse over time. But with this form of MS, you don’t have periods of relapse.
• Clinically isolated syndrome (CIS). CIS isn’t technically a form of MS. Instead, with CIS, you have an episode of MS-like symptoms that lasts at least 24 hours. CIS may or may not develop into MS.

Drug forms and administration

Rebif comes as a liquid solution. It’s available in single-dose, prefilled syringes. (The syringes can be used with an optional autoinjector device to help make administering your injections easier.) Rebif is also available in single-dose, prefilled devices called Rebif Rebidose autoinjectors.

Rebif is given by subcutaneous injection (an injection under your skin). It’s taken three times each week.

Avonex also comes as a liquid solution, and it’s available in both prefilled syringes and prefilled autoinjectors. Avonex is given by intramuscular injection (an injection into your muscle). It’s taken once each week.

Side effects and risks

Rebif and Avonex both contain interferon beta-1a. Therefore, these medications can cause very similar side effects. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with Rebif, with Avonex, or with both drugs (when taken individually).

• Can occur with Rebif:
  • belly pain
  • changes in certain blood tests that check your liver function
• Can occur with Avonex:
  • weakness
• Can occur with both Rebif and Avonex:
  • flu-like symptoms, such as muscle aches, fever, chills, and tiredness
  • injection site reactions
  • fatigue (lack of energy)

Serious side effects

These lists contain examples of serious side effects that can occur with Rebif, with Avonex, or with both drugs (when taken individually).

• Can occur with Rebif:
  • severe injection site reactions, which may cause pain or skin necrosis (death of skin cells)
• Can occur with Avonex:
  • heart problems, including heart failure
  • autoimmune disorders, including thyroid problems such as hypothyroidism (a condition that causes a low level of thyroid hormones)
• Can occur with both Rebif and Avonex:
  • liver effects, including liver damage
  • changes in blood cell levels
  • depression or thoughts of suicide
  • seizures
  • severe allergic reaction
  • thrombotic microangiopathy (a blood clotting disorder)

Effectiveness

The use of Rebif and Avonex in treating relapsing-remitting MS has been directly compared in a clinical study.

In a 48-week clinical study, Rebif treatment was compared with Avonex treatment. (Avonex is another medication used to treat MS.) In this study:

• 62% of people who took Rebif were relapse-free at 48 weeks.
• 52% of people who took Avonex had the same result.

Also, in this study, people who took Rebif had fewer brain or spinal cord lesions on MRI scans than people who took Avonex. (MRI scans are imaging tests used to check for brain or spinal cord lesions in people with MS. And lesions on the brain or spinal cord indicate areas of damage.)

For example, 50% of people who took 44 mcg of Rebif had an average of 0.17 lesions on each of their MRI scans. In comparison, 50% of people who took Avonex had an average of 0.33 lesions on each of their MRI scans.

Costs

Rebif and Avonex are both brand-name drugs. There are currently no generic forms of either drug. Brand-name medications usually cost more than generics.

Rebif generally costs more than Avonex. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Rebif vs. Copaxone

Like Avonex (discussed above), other drugs are prescribed for uses that are similar to those of Rebif. Here, we look at how Rebif and Copaxone are alike and different.

Ingredients

Rebif contains the active drug interferon beta-1a. This is a type of protein that occurs naturally in your body.

Copaxone contains the active drug glatiramer acetate. This is a combination of four amino acids (which are building blocks used to make proteins).

Uses

Rebif and Copaxone are both approved for use in adults with certain forms of multiple sclerosis (MS). Specifically, these drugs are approved to treat the following conditions:

• Relapsing-remitting MS. With relapsing-remitting MS, you have periods of time with either few MS symptoms or no MS symptoms, followed by periods of relapse. (With relapse, you have new or worsened MS symptoms.)
• Active secondary progressive MS. With active secondary progressive MS, your MS steadily gets worse over time. But with this form of MS, you don’t have periods of relapse.
• Clinically isolated syndrome (CIS). CIS isn’t technically a form of MS. Instead, with CIS, you have an episode of MS-like symptoms that lasts at least 24 hours. CIS may or may not develop into MS.

Drug forms and administration

Rebif comes as a liquid solution. It’s available in single-dose, prefilled syringes. (The syringes can be used with an optional autoinjector device to help make administering your injections easier.) Rebif is also available in single-dose, prefilled devices called Rebif Rebidose autoinjectors.

Rebif is given by subcutaneous injection (an injection under your skin). It’s taken three times each week.

Copaxone also comes as a liquid solution inside single-dose, prefilled syringes. It’s given by subcutaneous injection. Copaxone can be given either once each day or three times each week, depending on the strength of the drug you’re using.

Side effects and risks

Rebif and Copaxone both contain drugs used to treat multiple sclerosis (MS). Therefore, these medications can cause very similar side effects. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with Rebif, with Copaxone, or with both drugs (when taken individually).

• Can occur with Rebif:
  • flu-like symptoms, such as muscle aches, fever, chills, and tiredness
  • belly pain
  • changes in certain blood tests that check your liver function
• Can occur with Copaxone:
  • dilation (widening) of your blood vessels
  • rash
  • trouble breathing
  • chest pain
  • weakness
• Can occur with both Rebif and Copaxone:
  • injection site reactions
  • fatigue (lack of energy)

Serious side effects

These lists contain examples of serious side effects that can occur with Rebif, with Copaxone, or with both drugs (when taken individually).

• Can occur with Rebif:
  • liver effects, such as liver damage
  • changes in blood cell levels
  • depression or thoughts of suicide
  • seizures
  • thrombotic microangiopathy (a blood clotting disorder)
• Can occur with Copaxone:
  • postinjection reactions that may cause flushing, itching, chest pain, or a fast heart rate
  • weakened activity of your immune system
  • lipoatrophy (breakdown of fat cells at your injection sites)
• Can occur with both Rebif and Copaxone:
  • severe injection site reactions, which may cause pain and skin necrosis (death of skin cells)
  • severe allergic reaction

Effectiveness

The use of Rebif and Copaxone in treating relapsing-remitting MS has been directly compared in several clinical studies. And these studies were all evaluated together in one analysis.

The analysis showed that Copaxone and Rebif (as well as other interferon beta drugs similar to Rebif) were similarly effective in preventing MS relapses.

The analysis also showed that people who took Copaxone had slightly more MS lesions on MRI scans than people using other drugs, such as Rebif. (MRI scans are imaging tests used to check for brain or spinal cord lesions in people with MS. And lesions on the brain or spinal cord indicate areas of damage.)

Costs

Rebif and Copaxone are both brand-name drugs. There are currently no generic forms of Rebif. Brand-name medications usually cost more than generics.

Copaxone is available as a generic medication called glatiramer acetate. (Glatiramer acetate is the active drug in Copaxone.)

Rebif generally costs much more than both Copaxone and its generic drug, glatiramer acetate. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

How to take Rebif

You should take Rebif according to your doctor’s or healthcare provider’s instructions.

Rebif is taken as a subcutaneous injection (an injection under your skin). Your doctor will give you your first Rebif injection and show you how to administer the injections yourself. Then, you’ll be able to give yourself Rebif injections at home.

Rebif injection sites

The best places to inject Rebif into your body are areas where there’s a layer of fat between your skin and muscle. These areas are usually found on the:

• belly
• buttocks
• thighs
• outer part of your upper arm

If you have a low body weight, you should inject Rebif into your thigh or upper arm. There’s usually a bit more fat between your skin and muscle in these areas.

Regardless of your body weight, you should rotate your Rebif inject sites. To do this, choose a different area to inject the drug each time you take a dose of Rebif. Doing this will help reduce your risk of scarring or skin irritation at the injection sites.

Don’t inject Rebif in any area of skin that looks red, bruised, infected, or irritated. Injecting into these areas could increase your risk of irritation or infection.

How to take Rebif using single-dose, prefilled syringes

Rebif comes in single-dose, prefilled Rebidose autoinjectors and in single-dose, prefilled syringes. Here, we describe how to use the single-dose, prefilled syringes.

You can use Rebif prefilled syringes either by themselves or with devices called Rebiject II autoinjectors.

Using Rebif single-dose, prefilled syringes alone

When using Rebif syringes alone, administer the drug by following these steps:

1. Pinch the skin around your injection site to lift it up a bit.
2. Hold the syringe at a 90-degree angle from your skin. Use a quick, firm motion to insert the needle straight into your skin.
3. Once the needle is inserted, let go of the pinched skin and gently push the syringe plunger all the way down.
4. You can then remove the needle from your skin and gently apply pressure to the injection site with a clean cotton ball or gauze pad.
5. Make sure you throw away the used syringe into a sharps container. Monitor your injection site for any redness or swelling.

Using Rebif single-dose, prefilled syringes with a Rebiject II autoinjector

To use a Rebiject II autoinjector with a prefilled syringe, place the syringe into the autoinjector device. You can use the Rebiject II autoinjector for more than one dose of Rebif. Unlike the prefilled Rebidose autoinjector (discussed below), the Rebiject II autoinjector doesn’t need to be thrown away after each use.

Using the autoinjector device with Rebif syringes can help make administering the drug a bit easier for you. This is because the autoinjector allows you to adjust the depth of the needle in your skin. And with the device, you’ll have a nonslip grip of the Rebif syringe. In addition, the autoinjector device has a signal that lets you know when your dose has been fully injected.

You can find detailed instructions on how to use the Rebiject II autoinjector device on the manufacturer’s website.

How to take Rebif using single-dose, prefilled Rebidose autoinjectors

Rebif comes in single-dose, prefilled syringes and in single-dose, prefilled Rebidose autoinjectors. Here, we describe how to use the single-dose, prefilled Rebidose autoinjectors.

Rebif single-dose, prefilled Rebidose autoinjectors are fully assembled and ready to use. When using Rebidose autoinjectors, you can administer Rebif by following these steps:

1. First, pull the needle cap off of the autoinjector and throw it away.
2. Hold the Rebidose autoinjector in your palm, with your thumb hovering above the injector button.
3. Place the autoinjector against your skin at a 90-degree angle and push it against your skin until you feel some resistance. Keep the device pressed against your skin, and then use your thumb to push the injector button. You’ll hear a click, which indicates that the device has started injecting your dose of Rebif.
4. Keep the Rebidose autoinjector pressed against your skin for 10 seconds while the medication is being injected. Before removing the device from your skin, look to make sure that the device’s syringe plunger has moved all the way to the bottom. (This means that your entire dose has been injected.)
5. Then, lift the Rebidose autoinjector from your skin and throw it away into a sharps container.

For more detailed instructions on how to use the Rebidose autoinjector, visit the manufacturer’s website.

When to take

You’ll take Rebif injections three times each week.

It’s recommended that you inject the drug at the same time on each of your injection days. And it’s best to take your doses either late in the afternoon or sometime in the evening. You should try to give yourself your dose on the same 3 days every week. And make sure there are about 48 hours between each of your Rebif injections.

To make sure that you don’t miss a dose, try setting a reminder in your phone. A medication timer may be useful, too.

Rebif dosage

The Rebif dosage your doctor prescribes will depend on several factors. These include:

• the type and severity of the condition you’re using Rebif to treat
• your age
• other medical conditions you may have
• whether or not you have side effects while taking Rebif

Your doctor will start you on a low dosage and adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Rebif comes as a liquid solution. It’s available inside single-dose, prefilled syringes. (The syringes can be used with an optional autoinjector device to help make administering your injections easier.) Rebif is also available in single-dose, prefilled devices called Rebif Rebidose autoinjectors.

Both Rebif prefilled syringes and Rebif Rebidose autoinjectors come in the following strengths:

• 8.8 mcg per 0.2 mL
• 22 mcg per 0.5 mL
• 44 mcg per 0.5 mL

Rebif is given by subcutaneous injection (an injection under your skin). For more information about the different forms of Rebif and how each one is taken, see the section above called “How to take Rebif.”

Dosage for MS

The typical dosage of Rebif for multiple sclerosis (MS) is either 22 mcg or 44 mcg injected three times each week. However, when you’re first starting Rebif, you’ll take a lower dosage called a starting dosage.

For your starting dosage, your doctor will recommend that you take either 4.4 mcg or 8.8 mcg three times each week. Your doctor will gradually increase your dosage every 2 weeks. If you follow this dosing schedule, you should reach your full dosage of Rebif on your fifth week of treatment.

What if I miss a dose?

If you miss a dose of Rebif, take the missed dose as soon as you remember. Then, you should take your next dose of Rebif 48 hours later. You should never take more than two Rebif injections within a 48-hour period.

To help make sure that you don’t miss a dose, try setting a reminder in your phone. A medication timer may be useful, too.

Will I need to use this drug long term?

Rebif is meant to be used as a long-term treatment. If you and your doctor determine that Rebif is safe and effective for you, you’ll likely take it long term.

Common questions about Rebif

Here are answers to some frequently asked questions about Rebif.

Are there any side effects of stopping Rebif?

No. If you stop taking Rebif, you likely won’t have any side effects. However, your multiple sclerosis (MS) may flare up or worsen more quickly than it would if you continued treatment.

If you have questions about stopping Rebif, talk with your doctor. They can discuss with you the risks and benefits of stopping treatment.

Can Rebif cause PML?

It’s unlikely that Rebif will cause progressive multifocal leukoencephalopathy (PML). This is a rare brain infection that’s caused by the John Cunningham (JC) virus. PML infections can be dangerous. They can lead to swelling in your brain, and sometimes, they’re fatal.

Most people already have the JC virus in their bodies. In people with a healthy immune system, the virus doesn’t cause any harm to them. But in people with a weakened immune system, the virus can cause a PML infection.

Certain diseases and medications may weaken the activity of your immune system. Having a weakened immune system can increase your risk of PML.Some medications used to treat multiple sclerosis (MS) have been linked with PML.

Since Rebif’s approval for use, there have been rare cases of people developing PML while taking interferon beta-1a. (Interferon beta-1a is the active drug in Rebif.) But more research is needed to know for sure how often PML occurs in people taking Rebif.

If you have concerns about developing PML while using Rebif, talk with your doctor. They can discuss with you the risks and benefits of treatment.

Will Rebif cure my condition?

No, it won’t cure your condition. In fact, at this time, there’s no known cure for multiple sclerosis (MS).

But even though Rebif won’t cure your MS, it may help reduce the number of MS flare-ups you have. The drug may also help slow the development of physical disabilities caused by MS, such as trouble walking.

If you’d like to know more about the benefits of using Rebif, talk with your doctor.

Is Rebif a steroid?

No, Rebif isn’t a steroid. Rebif is a type of protein that occurs naturally in your body. This medication contains the active drug interferon beta-1a.

It’s not known exactly how Rebif works to treat multiple sclerosis (MS). But the drug has been shown to help reduce MS symptom flare-ups. Rebif has also helped delay disability caused by MS.

Will I need to have lab tests done during Rebif treatment?

Yes, you’ll likely need to have certain tests done during Rebif treatment.

For example, your doctor will probably order certain blood tests to check your liver enzymes and blood cell counts. This is because Rebif may lower the level of certain blood cells in your body. The drug may also affect your liver and increase your liver enzymes. For more information about Rebif’s effect on your liver, see the section above called “Rebif side effects.”

Your doctor may also order an imaging test called an MRI. This test allows your doctor to monitor lesions in your brain or spinal cord. (Lesions are areas of damage caused by multiple sclerosis [MS].)

If you have questions about the tests you may need during Rebif treatment, talk with your doctor.

How can I tell if Rebif is working for me?

It might be difficult for you to tell if Rebif is working to treat your multiple sclerosis (MS). This is especially the case if you usually go long periods of time without having MS flare-ups.

Rebif helps reduce MS symptom flare-ups and delay disability caused by the disease. So, over time, you should notice a reduction in the number of MS flare-ups you have.

If you’d like to know more about how you can tell if Rebif is working for you, talk with your doctor.

Rebif expiration, storage, and disposal

When you get Rebif from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee that the medication is effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk to your pharmacist about whether or not you can still use it.

Storage

How long a medication remains good can depend on many factors, including how and where you store the medication.

Both Rebif syringes and autoinjectors should be stored in the refrigerator. They should be kept at a temperature between 36°F and 46°F (2°C and 8°C). Rebif can be stored at this temperature until its expiration date. Do not freeze Rebif.

It’s also possible to store Rebif at a warmer temperature, between 36°F and 77°F (2°C and 25°C). However, if Rebif is stored out of the refrigerator at these temperatures, it’s only good for 30 days. This is because the drug doesn’t contain any preservatives.

In either case, store the drug away from heat and light.

Disposal

Right after you’ve used a Rebif syringe and needle, or a single-dose Rebif autoinjector device, you should dispose of it in an FDA-approved sharps disposal container. Doing this helps prevent others, including children and pets, from taking the drug by accident or harming themselves with the needle.

You can buy a sharps container online, or you can ask your doctor, pharmacist, or health insurance company where to get one.

This article provides several useful tips on medication disposal. You can also ask your pharmacist for information on how to safely dispose of your medication.

Rebif and alcohol

You should talk with your doctor before drinking alcohol while using Rebif. This is because both Rebif and alcohol may cause harm to your liver. And if they’re used together, your risk of liver problems can be significantly increased.

Before starting Rebif, tell your doctor if you regularly consume alcohol. Your doctor may check your liver enzymes (certain types of proteins) more frequently than usual during treatment. This allows your doctor to monitor the health of your liver.

If you have questions about the safety of drinking alcohol while using Rebif, talk with your doctor.

Rebif interactions

Rebif isn’t known to interact with any other medications, herbs, supplements, or foods.

However, before taking Rebif, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also, tell your doctor about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Rebif precautions

Before taking Rebif, talk with your doctor about your health history. Rebif may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

• Depression. While taking Rebif, it’s possible to have depression and thoughts of harming yourself or attempting suicide. If you have a history of depression, you may have a higher risk of these side effects during treatment. (And keep in mind that depression is common in people with multiple sclerosis [MS].) If you have a history of depression, be sure to talk with your doctor before starting Rebif.
• Liver problems. While using Rebif, it’s possible to have liver damage. This side effect has rarely resulted in the need for a liver transplant. You may have a higher risk of liver damage caused by Rebif if you have a history of liver problems, such as fatty liver or hepatitis (inflammation in your liver). Be sure to talk with your doctor about your liver health before starting Rebif. Your doctor will likely order certain blood tests to monitor the health of your liver during treatment.
• Alcohol consumption. Because both Rebif and alcohol can damage your liver, be sure to tell your doctor if you drink alcohol. They’ll determine whether or not Rebif is the best treatment choice for you. And they’ll help determine how much, if any, alcohol is safe for you to drink while taking this drug.
• Bleeding problems or a history of blood clots. If you’ve had problems with bleeding or blood clots, talk with your doctor before taking Rebif. This drug may increase your risk of bleeding or blood clotting problems.
• Seizure disorder. Seizures are a rare side effect of Rebif and similar medications. If you have a history of seizures, you may have a higher risk of seizures while taking Rebif. Talk with your doctor about any history of seizures before starting Rebif.
• Allergic reaction. If you’ve ever had an allergic reaction to a drug that contains interferon beta, albumin, mannitol, or sodium acetate, you should not take Rebif. Be sure to talk with your doctor about your allergies before starting any new medications.
• Allergy to albumin. If you’ve ever had an allergic reaction to a drug that contains albumin, you should not take Rebif. You should also avoid taking Rebif if you’ve ever had an allergic reaction to interferon beta or any of Rebif’s other ingredients. For information about this, see the bullet just above.
• Pregnancy. It’s not known if it’s safe for pregnant women to take Rebif. For more information, please see the “Rebif and pregnancy” section below.
• Breastfeeding. It’s not known if it’s safe to breastfeed a child while taking Rebif. For more information, please see the “Rebif and breastfeeding” section below.

Note: For more information about the potential negative effects of Rebif, see the “Rebif side effects” section above.

Rebif and pregnancy

It’s not known if Rebif is safe to take during pregnancy. There haven’t been any studies done in pregnant women taking the drug.

One animal study looked at using medication similar to Rebif in pregnant monkeys. This study didn’t show any negative effects on fetuses exposed to the drug. However, keep in mind that animal studies don’t always predict what will happen in humans. And this study didn’t show that Rebif specifically was safe to take during pregnancy.

If you’re pregnant or thinking of becoming pregnant, talk with your doctor. They can determine whether or not it’s safe for you to use Rebif.

Rebif and birth control

It’s not known if Rebif is safe to take during pregnancy. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while using Rebif.

Rebif and breastfeeding

It’s not known if Rebif is safe to take while breastfeeding. There haven’t been any large studies done to test whether or not Rebif is passed into human breast milk.

If you’re breastfeeding and considering taking Rebif, talk with your doctor. They can recommend safe and healthy ways for you to feed your child.

Rebif cost

As with all medications, the cost of Rebif can vary.

The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

It’s important to note that you may have to get Rebif at a specialty pharmacy. This type of pharmacy is authorized to carry specialty medications. These are drugs that may be expensive or may require help from healthcare professionals to be used safely and effectively.

Your insurance plan may require you to get prior authorization before they approve coverage for Rebif. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the request and let you and your doctor know if your plan will cover Rebif.

If you’re not sure if you’ll need to get prior authorization for Rebif, contact your insurance provider.

Financial and insurance assistance

If you need financial support to pay for Rebif, or if you need help understanding your insurance coverage, help is available.

EMD Serono, Inc., the manufacturer of Rebif, provides financial support specialists who can help you find ways to reduce the cost of Rebif. For more information and to find out if you’re eligible for financial support, call 877-447-3243 or visit the program website.

Generic or biosimilar version

Rebif contains the active drug interferon beta-1a, which is a protein that’s made by living cells. Because it’s made from living cells, Rebif is called a biologic drug.

Rebif is available only as a brand-name medication. It’s not currently available in biosimilar form.

A biosimilar drug is a medication that’s similar to a brand-name biologic drug. A generic drug, on the other hand, is an exact copy of the active drug in a brand-name medication that’s made from chemicals. But because biologic drugs are made from living cells, it’s not possible to copy these drugs exactly.

Usually, the generic or biologic form of a drug costs less than the brand-name form.

How Rebif works

Rebif is approved to treat certain forms of multiple sclerosis (MS). The drug is also approved to treat clinically isolated syndrome (CIS), which is a condition that causes MS-like symptoms. (Because MS and CIS affect your body in similar ways, these conditions are often discussed together as “MS.”)

With MS, your immune system attacks the protective covering around your nerve cells, called the myelin sheath. This damage reduces the communication between your brain and the nerves in the rest of your body.

It’s not known for sure what causes MS. But some people think it’s caused by some sort of infection that triggers your immune system to overreact.

Because the cause of MS isn’t known for sure, it’s hard to know exactly how Rebif works to treat the condition. But the drug has been shown to reduce MS relapses and delay disability caused by the disease.

How long does it take to work?

Every person’s body is different, which means that MS affects each person differently. Some people have long periods of time with no MS symptoms, while other people have shorter times with no MS symptoms. And flare-ups of MS symptoms can last for different lengths of time in different people.

Rebif is used to help reduce MS symptom relapses and delay disability caused by the disease. But because MS affects people differently, it’s not known for sure how long it will take for Rebif to work to treat your MS.

Rebif overdose

Do not use more Rebif than your doctor recommends. For some drugs, taking more than recommended may cause unwanted side effects or overdose.

What to do if you take too much Rebif

If you think you’ve taken too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.