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Interferon beta-1a

Interferon beta-1a is a recombinant glycoprotein form of the naturally occurring human cytokine interferon beta, consisting of 166 amino acids with a molecular weight of approximately 22,500 daltons, produced using genetically engineered Chinese hamster ovary (CHO) cells expressing the human interferon beta gene. It functions as an immunomodulator by binding to specific cell surface receptors, thereby inducing the expression of genes that mediate antiviral, antiproliferative, and immune-modulating activities, including the upregulation of proteins such as 2',5'-oligoadenylate synthetase and β2-microglobulin. Primarily indicated for the treatment of relapsing forms of multiple sclerosis (MS) in adults, including clinically isolated syndrome (CIS), relapsing-remitting MS, and active secondary progressive MS, it reduces the frequency of clinical exacerbations, delays the accumulation of physical disability, and decreases inflammation and nerve damage associated with the disease, though it does not cure MS. Available under brand names such as Avonex (administered as an intramuscular injection once weekly) and Rebif (administered as a subcutaneous injection three times weekly), interferon beta-1a was first approved by the U.S. Food and Drug Administration (FDA) in 1996 for Avonex, with Rebif following in 2002 and a pegylated variant, Plegridy, in 2014, establishing it as one of the earliest disease-modifying therapies for MS. Clinical trials, including the pivotal Phase 3 studies for Avonex and Rebif, have demonstrated its efficacy in reducing annualized relapse rates by approximately 30% and improving magnetic resonance imaging (MRI) measures of disease activity, such as the number of gadolinium-enhancing lesions. While generally well-tolerated, common side effects include flu-like symptoms, injection-site reactions, and elevated liver enzymes, with monitoring recommended for hepatic function and neutralizing antibodies that may reduce efficacy over time. Its role as a first-line therapy persists due to a favorable safety profile and sustained benefits observed in long-term extensions like the ATTAIN trial, which showed maintained efficacy over six years with peginterferon beta-1a.

Chemistry and production

Molecular structure and properties

Interferon beta-1a is a recombinant composed of 166 , with an sequence identical to that of naturally occurring human interferon beta. The protein features a single N-linked site at residue 80 (Asn80), which attaches a complex moiety, contributing to its structural integrity and biological . This pattern is achieved through in Chinese hamster ovary (CHO) cells, ensuring a mammalian-like comparable to the endogenous human form. The molecular formula of the unglycosylated polypeptide is C908H1408N246O252S7, with a predicted molecular weight of 20,027 Da. The has a molecular weight of approximately 22.5 kDa. The enhances the protein's pharmacokinetic profile by improving in aqueous media and to , while the core polypeptide includes five residues forming one intramolecular bond (between Cys31 and Cys141) that stabilizes the tertiary structure. Interferon beta-1a is highly soluble in neutral aqueous buffers, forming clear, colorless solutions at physiological concentrations. It maintains at 7.4 under refrigerated conditions (2–8°C), but is susceptible to aggregation induced by mechanical agitation or , as well as denaturation from freezing or exposure to extreme temperatures. Storage recommendations emphasize protection from light and avoidance of shaking to preserve monomeric form and bioactivity. In comparison to , which is an unglycosylated, bacterially derived protein with 155 (lacking the C-terminal 11 residues of the natural sequence and featuring a serine at position 17), beta-1a exhibits a more native-like conformation due to its and full-length sequence, potentially influencing its and .

Recombinant production methods

Interferon beta-1a is manufactured through technology, primarily using ovary (CHO) cells as the expression host to produce a glycosylated protein mimicking the natural human form. The process begins with gene cloning, where the human IFN-beta gene is isolated and inserted into mammalian expression vectors, such as those containing promoters like the (CMV) promoter for stable integration into the CHO cell genome. These vectors are then transfected into CHO cells via methods like or lipofection, selecting stable cell lines that express high levels of the protein through resistance markers or (DHFR) amplification systems. Following , the engineered cells are expanded and cultured in large-scale bioreactors to produce interferon beta-1a. These cultures are maintained under tightly controlled conditions, including temperatures around 37°C, levels between 6.8 and 7.2, dissolved oxygen at 30-50%, and nutrient feeds supplemented with glucose, , and vitamins to support high-density growth up to 10^7 cells/mL. The process typically employs fed-batch or modes in or single-use bioreactors, with harvest occurring after 10-14 days when productivity peaks, yielding titers of up to approximately 20 mg/L of interferon beta-1a. Purification of interferon beta-1a from the cell culture supernatant involves a multi-step chromatographic process to isolate the protein while removing host cell proteins, DNA, and process-related impurities. Initial capture often uses affinity chromatography with ligands like monoclonal antibodies or blue sepharose to bind the protein specifically, followed by ion-exchange chromatography (e.g., anion or cation exchange) to separate based on charge differences. Subsequent steps include hydrophobic interaction chromatography (HIC) to exploit the protein's surface hydrophobicity under high-salt conditions, and ultrafiltration/diafiltration for concentration and buffer exchange, achieving purity greater than 99%. Viral inactivation and clearance are integrated, such as through low pH treatment or nanofiltration, to meet biosafety requirements. Quality control measures ensure batch-to-batch consistency and compliance with regulatory standards set by the FDA and EMA. Each lot undergoes testing for bioactivity using antiviral cytopathic effect assays to confirm specific activity above 200 × 10^6 IU/mg, sterility via microbial challenge tests, and quantification of host cell proteins and DNA below 100 ppm and 10 pg/mg, respectively. Structural integrity, including glycosylation patterns, is verified by techniques like capillary electrophoresis and mass spectrometry, with release criteria aligned to ICH guidelines for biopharmaceuticals. Historically, the production of beta shifted from prokaryotic systems to mammalian cells for the -1a variant to achieve proper post-translational modifications like , which are absent in coli-derived beta-1b. Early development of beta-1b by utilized E. coli for non-glycosylated protein in the 1980s, but adopted cells in the for Avonex (BG9216 process), enabling secretion of a fully glycosylated, soluble form with enhanced stability and reduced . This mammalian approach became standard for beta-1a products like Avonex and Rebif, reflecting the need for native-like folding and bioactivity.

Medical uses

Relapsing forms of

Interferon beta-1a is approved for the treatment of relapsing forms of (), including relapsing-remitting (RRMS) and active secondary progressive (SPMS), where it serves as a first-line disease-modifying to reduce relapse frequency and slow accumulation. Pivotal evidence comes from the PRISMS trial, a randomized, double-blind, -controlled study involving 560 patients with RRMS, which demonstrated that subcutaneous interferon beta-1a at 44 mcg three times weekly reduced the annualized rate by 33% compared to over two years, alongside a 32% reduction in the risk of progression to confirmed . Across broader clinical data for relapsing , interferon beta-1a reduces annualized rates by 18-38% relative to , with corresponding decreases in MRI measures of disease activity, such as approximately 30% fewer new or enlarging T2 lesions and gadolinium-enhancing lesions. Long-term use of interferon beta-1a, particularly when initiated early in the disease course, provides sustained benefits in relapsing by slowing disability progression and delaying transition to non-relapsing phases. In the 15-year extension of the PRISMS trial (PRISMS-15), patients receiving higher cumulative doses of subcutaneous interferon beta-1a (44 mcg three times weekly) experienced lower annualized relapse rates (0.37 versus 0.50 for lower doses), reduced confirmed (EDSS) progression (52.8% versus 68.5%), and markedly lower conversion to SPMS (20.8% versus 52.1%). A 20-year further supported these findings, showing that early initiation of beta therapy reduced the risk of reaching EDSS 6.0 by 37% and lowered conversion to SPMS by 35% compared to delayed treatment. These outcomes underscore the value of prompt intervention in active relapsing disease to modify long-term trajectories. Up to 30% of patients with relapsing treated with interferon beta-1a develop neutralizing antibodies (NAbs) over time, which can diminish therapeutic efficacy by impairing the drug's and . Incidence varies by and dose, with subcutaneous regimens showing higher rates (around 20-25% at two years) than intramuscular, and NAb positivity typically emerging after 12-18 months of therapy. In NAb-positive patients, rates increase significantly (p=0.04), worsens more rapidly (p=0.01), and MRI lesion accrual accelerates, including greater numbers of gadolinium-enhancing lesions (p=0.02 at 24 months) and new T2 lesions (p=0.05). Regular monitoring for NAbs is recommended, as persistent high titers correlate with loss of response.70103-4/fulltext) Patient selection for interferon beta-1a in relapsing favors individuals with early active disease, such as those with frequent relapses or high MRI burden, as guidelines emphasize its role in reducing and formation in these populations. It is recommended for treatment-naive patients or those with mild to moderate (EDSS ≤5.5), but not for primary progressive , where clinical trials have shown no significant benefit on progression or relapses. According to American Academy of (AAN) guidelines, interferon beta-1a should be offered to patients with relapsing to mitigate relapse risk, with shared decision-making considering factors like disease activity and tolerability. European Committee for Treatment and Research in (ECTRIMS) guidelines similarly endorse it for relapsing forms, excluding primary progressive cases.

Clinically isolated syndrome

Clinically isolated syndrome () is defined as the first episode of neurologic symptoms lasting at least 24 hours, caused by inflammation and demyelination in the , such as , incomplete , or brainstem/cerebellar syndromes, often accompanied by MRI evidence of ()-like lesions. In high-risk CIS patients—those with at least two brain MRI lesions characteristic of MS—interferon beta-1a has been shown to delay progression to clinically definite MS (CDMS). The pivotal Controlled High-Risk Avonex Multiple Sclerosis Prevention Study () trial, involving 383 patients aged 18-50 with recent and abnormal baseline MRI (≥2 lesions ≥3 mm, at least one periventricular or ovoid), demonstrated that weekly intramuscular interferon beta-1a (30 μg) reduced the risk of developing CDMS by 44% compared to ( 0.56; 95% CI 0.38-0.81; P=0.002). By three years, the cumulative probability of CDMS was 35% versus 50%, representing an approximate 30% absolute risk reduction. The trial also showed reduced MRI lesion activity, including a 67% decrease in gadolinium-enhancing lesions at 18 months (P<0.001). Long-term follow-up in the study confirmed sustained benefits, with immediate interferon beta-1a initiation reducing relapse rates over 10 years in high-risk CIS patients. Subgroup analyses of CHAMPS data further supported efficacy across clinical presentations (e.g., optic neuritis) and MRI characteristics, with greater risk reductions (up to 44%) in patients with ≥9 T2 lesions or gadolinium enhancement at baseline. Similar results have been observed in other interferon beta-1a studies for early demyelinating events, reinforcing its role in preventing MS conversion. Current guidelines from the American Academy of (AAN) recommend discussing and offering interferon beta-1a or other disease-modifying therapies to high-risk CIS patients with ≥2 characteristic MRI lesions who choose treatment after risk-benefit counseling (Level B ). The European Committee for Treatment and Research in (ECTRIMS) and European Academy of (EAN) strongly endorse interferon beta-1a for CIS patients with abnormal MRI suggestive of MS, even if not yet meeting full MS criteria, based on of delayed CDMS (hazard ratio 0.49; 95% CI 0.38-0.64 across trials). Monitoring in treated CIS patients typically involves serial MRI scans to assess lesion progression and detect subclinical activity, guiding decisions on therapy continuation or adjustment.

Other indications

Interferon beta-1a has been investigated for the treatment of condyloma acuminatum, a condition caused by human papillomavirus leading to , through intralesional injection. A randomized, double-blind, -controlled demonstrated that recombinant beta administered intralesionally resulted in wart regression in some patients, with complete clearance observed in approximately 50% of treated lesions compared to . This approach received historical FDA approval for limited use in refractory cases, but its application has declined due to the availability of more effective topical and surgical options, rendering it of limited current clinical utility. In the context of hepatitis C virus infection, interferon beta-1a has been explored off-label as an adjunct to standard combination therapies prior to the widespread adoption of direct-acting antivirals (DAAs) around 2011. Studies, including a prospective randomized pilot trial combining recombinant interferon beta-1a with , reported modest reductions in , with sustained virologic response rates around 30-40% in certain genotypes, though inferior to interferon alpha-based regimens. Safety profiles indicated potential for similar adverse effects as in treatment, but efficacy was limited, and its use has largely been supplanted by DAAs, which achieve cure rates exceeding 95% without . Emerging research has examined interferon beta-1a in trials for (NMOSD) and other autoimmune conditions, such as through observational studies and small cohorts assessing its immunomodulatory effects. However, clinical evidence suggests it may exacerbate disease activity in NMOSD, with reports of increased aquaporin-4 levels and rates in treated patients, leading to recommendations against its use. No approvals have been granted for these indications, and ongoing trials emphasize the need for caution due to potential risks. Despite these explorations, robust evidence supporting interferon beta-1a beyond remains lacking. As of 2025, guidelines from regulatory bodies like the FDA and clinical societies affirm its primary role in relapsing forms of MS and . Off-label applications are not routinely recommended owing to inconsistent efficacy and safety concerns in non-MS contexts.

Pharmacology

Mechanism of action

Interferon beta-1a, a type I , exerts its therapeutic effects primarily by binding to the heterodimeric receptor composed of IFNAR1 and IFNAR2 on the surface of target cells, such as immune cells and endothelial cells. This binding induces receptor dimerization, which activates the Janus . Specifically, it leads to the of JAK1 and TYK2 kinases, subsequent activation of STAT1 and STAT2 transcription factors, and their translocation to the , where they form a with interferon regulatory factor 9 (IRF9) to drive the transcription of hundreds of interferon-stimulated genes (ISGs). Through this pathway, interferon beta-1a modulates the immune response in multiple ways. It upregulates the expression of (MHC) molecules on cell surfaces, enhancing to cytotoxic + T cells and promoting the targeting of infected or abnormal cells by macrophages. Additionally, it shifts the immune balance toward anti-inflammatory states by reducing the differentiation and activity of pro-inflammatory T helper 1 (Th1) and Th17 cells, while increasing the number and function of regulatory T cells (Tregs), which suppress excessive immune responses. This also involves the downregulation of pro-inflammatory cytokines such as interferon-gamma and interleukin-17, coupled with upregulation of anti-inflammatory cytokines like interleukin-10. In terms of , interferon beta-1a promotes the production of (NGF) by brain microvascular endothelial cells and other neural support cells, supporting neuronal survival and repair in the context of inflammatory damage. It further contributes to by decreasing blood-brain barrier (BBB) permeability, thereby limiting the influx of inflammatory mediators and immune cells into the (CNS). The antiviral properties of interferon beta-1a stem from its induction of ISGs such as 2'-5' oligoadenylate synthetase () and R (PKR), which activate pathways leading to the degradation of and inhibition of synthesis, thereby restricting viral replication within infected cells. In (), interferon beta-1a specifically attenuates disease progression by lowering the expression of matrix metalloproteinases (MMPs), particularly MMP-9 and MMP-7, which are enzymes that degrade components and facilitate T-cell migration across the into the CNS. This reduction in MMP activity helps to stabilize the and curb the autoimmune attack on sheaths.

Pharmacokinetics

Interferon beta-1a exhibits variable depending on the , with intramuscular () and subcutaneous () formulations showing distinct profiles. Following IM injection, as used in products like Avonex, serum concentrations peak at approximately 15 hours post-dose (range: 6 to 36 hours) due to prolonged absorption from the injection site. For SC administration, as in Rebif, the median time to peak concentration (Tmax) is approximately 16 hours after a 60 mcg dose, with a maximum concentration (Cmax) of about 5.1 IU/mL. Overall is approximately 30% for both IM and SC routes, reflecting incomplete absorption of this large . The volume of distribution for interferon beta-1a ranges from 0.25 to 2.88 L/kg, consistent with distribution primarily into , as the molecule's size limits extensive intracellular penetration. Limited data indicate no significant , and tissue distribution studies are constrained by assay challenges, but the drug remains largely in the vascular and interstitial spaces. Metabolism of interferon beta-1a occurs primarily through proteolytic degradation in peripheral tissues and the kidneys, without involvement of hepatic enzymes. This catabolic process aligns with the general clearance mechanisms for recombinant glycoproteins, leading to fragments that are further degraded or excreted. Elimination is mainly renal, with total body clearance of 33 to 55 L/hour reported for administration. The elimination varies by route: approximately 19 hours (range: 8 to 54 hours) for injection and up to 69 hours (mean ± SD: 69 ± 37 hours) for , reflecting differences in rather than intrinsic clearance. Pharmacokinetics demonstrate dose proportionality, with linear increases in area under the curve (AUC) and Cmax over the clinical dose range of 30 to 60 mcg. The development of neutralizing antibodies can impact by reducing drug exposure; patients with persistent high-titer antibodies experience approximately 20% to 40% lower and biologic activity compared to antibody-negative individuals. This reduction arises from antibody-mediated clearance and blockade of receptor binding, though exact effects vary by antibody and method.

Administration and dosing

Dosage regimens

Interferon beta-1a is administered at a standard dose of 30 micrograms intramuscularly once weekly for the treatment of relapsing forms of (MS) using the Avonex . For the Rebif , the recommended dose is 44 micrograms subcutaneously per week, with injections spaced at least apart. These regimens apply to adults with relapsing-remitting MS, active secondary progressive MS, and (CIS) suggestive of MS. To minimize flu-like symptoms upon initiation for both and , dosing is typically titrated upward over the first 4 weeks. For Avonex, treatment begins at 7.5 micrograms in week 1, increases to 15 micrograms in week 2, 22.5 micrograms in week 3, and reaches the full 30 micrograms dose from week 4 onward. For Rebif targeting 44 micrograms, the schedule starts at 8.8 micrograms three times weekly in weeks 1 and 2, escalates to 22 micrograms in weeks 3 and 4, and achieves the maintenance dose of 44 micrograms from week 5. Dose adjustments may be necessary for severe adverse effects, such as significant reductions in peripheral blood counts or elevations in liver enzymes; in these cases, the dose can be reduced by 20 to 50% or temporarily interrupted until resolution, followed by gradual re-escalation. Therapy discontinuation may be considered if persistent neutralizing antibodies develop and are associated with loss of clinical response. Interferon beta-1a is not approved for pediatric use, as and have not been established in patients under 18 years of age. As of 2025, regulatory agencies have not approved its use in this population; off-label administration in adolescents with has involved starting at half the adult dose and titrating to full adult doses based on tolerance and response, though data remain limited. Routine monitoring during the initial phase of therapy includes complete blood counts () and at 1, 3, and 6 months after initiation, and periodically thereafter to detect hematologic or hepatic abnormalities (per Rebif labeling); similar periodic assessments are recommended for other formulations.

Routes and formulations

Interferon beta-1a is primarily administered via intramuscular () or subcutaneous () injection, with formulations designed for self-administration using prefilled syringes or to enhance patient convenience. The IM route, exemplified by Avonex, involves a prefilled delivering 30 micrograms in 0.5 mL of solution directly into a muscle, typically the , , or buttock, once weekly. In contrast, the SC route is used for products like Rebif, which is available in prefilled syringes or the RebiDose autoinjector at doses of 22 micrograms or 44 micrograms, injected into the , , buttock, or three times weekly. A pegylated , Plegridy (peginterferon beta-1a), extends the dosing interval and is administered subcutaneously or intramuscularly using a prefilled pen or at 125 micrograms every two weeks, allowing for less frequent injections while maintaining therapeutic levels. These devices are engineered for ease of use, with autoinjectors providing automated needle insertion and to reduce injection-related anxiety. Patients receive training from healthcare providers on proper self-injection techniques, including site preparation and needle disposal, to ensure safe and effective home administration. Rotation of injection sites is recommended across administrations to minimize localized discomfort. All formulations require at 2°C to 8°C (36°F to 46°F) for long-term storage to preserve stability, though they may be kept at (up to 25°C or 77°F) for limited periods—up to 7 days for Avonex, and up to 30 days for Rebif and Plegridy—before use. Biosimilars, such as CinnoVex, offer comparable formulations at 30 micrograms, produced via recombinant methods in cells and approved in regions like for relapsing treatment.

Adverse effects

Common side effects

Common side effects of interferon beta-1a, primarily derived from subcutaneous (Rebif) and intramuscular (Avonex) formulations, are generally mild and transient, affecting a majority of patients during initial treatment. These include flu-like symptoms such as fever, chills, , and , which occur in approximately 50-65% of patients early in therapy and often diminish within 3-6 months with continued use or dose . Injection-site reactions, manifesting as pain, erythema, swelling, or , are reported in 50-92% of patients depending on the , with subcutaneous dosing associated with higher rates (89-92%) compared to intramuscular (3-8%); necrosis at the site is rare, occurring in 1-3% of cases. Laboratory abnormalities, including (leukopenia in 28-36%) and elevated liver enzymes (/ in 20-27%), are observed in 10-36% of patients and typically require quarterly monitoring. Fatigue and headache are also prevalent, impacting 24-41% and 58-70% of patients, respectively, with incidence reduced through gradual dose escalation. In the PRISMS trial for relapsing-remitting , over 10% of patients discontinued subcutaneous interferon beta-1a due to tolerability issues, while the CHAMPS trial for reported lower discontinuation rates (<1%) related to adverse events with intramuscular administration. These symptoms can often be managed with nonsteroidal drugs or acetaminophen, particularly for flu-like symptoms occurring post-injection.

Serious adverse effects

Interferon beta-1a therapy has been associated with rare but severe hepatic injury, including occurring in less than 1% of patients, with isolated cases progressing to fulminant or requiring transplantation. Symptoms such as , , and may emerge 1 to 6 months after initiation, necessitating regular monitoring of and prompt discontinuation if elevation exceeds three times the upper limit of normal. Fatal hepatic outcomes have been reported in , particularly in patients with preexisting liver conditions. Neuropsychiatric effects represent a significant , with reported in approximately 25% of treated patients compared to 19% on , and or attempts occurring in 5% to 10% of cases, often within the first few months of therapy. Patients with a history of psychiatric disorders require careful screening prior to initiation, and therapy should be discontinued if severe or psychotic features develop, as these can lead to life-threatening outcomes. Hematologic complications include in 4% to 8% of patients and in about 5%, with rare instances of severe reductions (platelet counts below 10,000/μL) or increasing infection risk; has been reported in postmarketing experience. These effects are typically dose-related and reversible upon discontinuation, but monitoring of complete blood counts is recommended every 3 to 6 months to detect early changes. Hypersensitivity reactions, though rare, encompass manifesting as urticaria, , or , requiring immediate discontinuation and supportive care. Antibody development against interferon beta-1a can also induce thyroid dysfunction, including or in up to 10% of patients, with new-onset cases reported postmarketing; baseline and periodic are advised. Pulmonary arterial hypertension (PAH), a serious condition that can lead to right-sided , has been reported rarely with beta products, including beta-1a formulations, typically after months to years of . Symptoms may include new or worsening dyspnea or , and discontinuation is recommended if PAH is confirmed by . Thrombotic microangiopathy (TMA), including and , has been reported rarely, sometimes leading to renal failure or death. It may occur after months of therapy and requires immediate discontinuation if suspected based on clinical or laboratory findings such as new or renal impairment. Long-term use has not confirmed an increased risk of , with clinical trials showing no significant elevation compared to the general population. However, (PML), a rare , has been linked to with , with cases reported after 2 years of dual exposure due to enhanced . Adverse events are tracked through , including the FDA's MedWatch program, which has captured rare reports of severe outcomes to inform updated labeling and risk mitigation strategies.

Contraindications and precautions

Contraindications

Interferon beta-1a is contraindicated in patients with a of to natural or recombinant interferon beta, human albumin, or any other component of the formulation, as severe allergic reactions may occur. Use with caution or avoid initiation in patients with severe hepatic impairment, as the drug has not been studied in this population; monitor closely due to the risk of exacerbating hepatic injury, including rare cases of severe hepatic failure. Caution is advised in patients with uncontrolled , as interferon beta-1a may exacerbate seizures, particularly in those with a history of severe or uncontrolled seizures; monitor closely. Regarding pregnancy, interferon beta-1a was previously classified as FDA C, but this designation was removed in 2020 based on observational human data showing no increased risk of major birth defects, , or ; however, animal studies demonstrated teratogenicity, and use is recommended only if the potential benefit justifies the potential risk to the . For , interferon beta-1a is not contraindicated; as of 2025, it is considered safe, with low levels in human milk, minimal oral absorption by the , and no reported adverse effects on breastfed infants, though caution is advised. These contraindications align with updated FDA and prescribing guidelines as of 2023, emphasizing individualized .

Drug interactions

Interferon beta-1a may interact with various medications, potentially altering their or increasing the of adverse effects, primarily through effects on hepatic enzymes and immune . No formal drug interaction studies have been conducted in humans, but clinical observations and data indicate potential issues with drugs metabolized by (CYP) enzymes, as interferons can reduce their activity. Patients should inform healthcare providers of all concomitant medications to allow for appropriate monitoring. Hepatotoxic drugs, such as and , can pose an additive risk of when used with interferon beta-1a, as both the and these agents may independently cause . For instance, chronic or excessive consumption has been noted to exacerbate liver enzyme elevations associated with therapy, necessitating regular monitoring of (LFTs). Similarly, co-administration with , a known hepatotoxin used in some autoimmune conditions, may heighten this risk, though combination use has been explored in limited studies without specific dose adjustments mandated. Immunosuppressants like corticosteroids may reduce the immunomodulatory efficacy of interferon beta-1a, as corticosteroids can counteract interferon-induced immune activation; however, they are commonly co-prescribed during relapses with clinical evidence supporting their combined use under . Caution is advised with mitoxantrone due to potential additive risks of severe adverse effects, including myelosuppression and ; monitor closely if co-administered. Live , such as measles-mumps-rubella (MMR), may elicit a diminished in patients receiving interferon beta-1a due to its immunomodulatory effects, and vaccination should be delayed if possible until after treatment discontinuation to optimize . Inactivated are generally unaffected, but consultation with a healthcare provider is recommended. Anticoagulants like may experience decreased metabolism when combined with interferon beta-1a, potentially leading to elevated international normalized ratio (INR) levels and increased bleeding risk; close INR monitoring is advised during initiation or dose changes of interferon therapy. Interferon beta-1a exhibits minor inhibition of , which may slightly prolong the clearance of substrates like , but no major dose adjustments are typically required based on pharmacokinetic data. Other CYP substrates, such as certain antidepressants or antiepileptics with narrow therapeutic indices, warrant similar caution and if co-administered. Clinical evidence from and post-approval studies in the 2020s, including real-world safety analyses of interferon beta-1a in patients, confirm these interactions without identifying new major concerns, emphasizing the importance of individualized risk assessment.

History

Development and discovery

Interferons were first identified in 1957 by British virologist and Swiss researcher Jean Lindenmann during experiments on in allantoic , where they observed a soluble factor produced by virus-infected cells that protected uninfected cells from subsequent infection. The beta subtype of interferon, primarily secreted by s in response to stimuli, was cloned from sources in early 1980 through collaborative efforts involving cDNA synthesis from induced fibroblast mRNA, enabling the sequencing of the IFN-β gene. In the early 1980s, preliminary open-label studies explored natural human derived from cultures, administered intrathecally to patients with relapsing-remitting , revealing significant reductions in frequency and attack duration compared to historical controls. Recombinant of human marked a key advancement, with the gene's initial expression achieved in in 1980, allowing scalable manufacturing free from viral contamination risks associated with natural sources; advanced this further by securing patents in 1984 for recombinant processes and developing a ovary (CHO) cell expression system for the glycosylated IFN-β-1a form. Preclinical investigations from 1985 to 1990 using experimental autoimmune encephalomyelitis (EAE) models in rodents demonstrated that IFN-β modulated immune responses by suppressing T-cell proliferation, reducing production, and attenuating demyelination, providing early evidence of its potential therapeutic mechanism in autoimmune demyelination.

Regulatory approvals

Interferon beta-1a, marketed as Avonex by , received its initial regulatory approval from the U.S. (FDA) on May 17, 1996, based on the Phase 3 MSCRG trial, for reducing the frequency of clinical exacerbations in patients with relapsing-remitting (RRMS). The (EMA) granted approval for Avonex on March 13, 1997, for the treatment of RRMS in adults. In January 2009, the FDA expanded Avonex indications to include (CIS) for reducing the risk of progression to definite MS. In June 2022, the FDA further approved Avonex for pediatric patients aged 12 years and older with RRMS. Another formulation, Rebif from (now EMD Serono), was approved by the on May 4, 1998, based on the Phase 3 PRISMS trial, for the treatment of RRMS. The FDA approved Rebif on March 7, 2002, expanding its indications to include RRMS and , the first clinical episode suggestive of . The approved Rebif for pediatric use in patients aged 12 years and older with RRMS in 2018. A pegylated variant, Plegridy (peginterferon beta-1a) from , was approved by the FDA on April 11, 2014, based on the Phase 3 ADVANCE and CONFIRM trials, and by the on July 18, 2014, for the treatment of relapsing forms of . Biosimilars of interferon beta-1a have emerged in select markets, with Cinnovex (CinnaGen) receiving approval from the Iranian Food and Drug Organization in 2005 as the first for RRMS treatment. In the , development for interferon beta-1a remains pending as of , with no approvals granted to date amid ongoing regulatory reviews for complex biologics. Globally, interferon beta-1a formulations are approved in more than 90 countries, reflecting widespread recognition for management. It is also included on the World Health Organization's Model List of for treatment in low-resource settings.

Society and culture

Brand names and manufacturers

Interferon beta-1a is marketed under several brand names worldwide, primarily for the treatment of relapsing forms of . The major originator products include Avonex, developed and manufactured by Inc., which is administered as a weekly . Rebif, another key brand, is produced by EMD Serono, a of Merck KGaA, in collaboration with in certain markets, and is available as a subcutaneous injection. Plegridy, a pegylated form of interferon beta-1a (peginterferon beta-1a), is also manufactured by Inc. and offers a less frequent dosing schedule. Biosimilars have emerged in various regions, particularly in emerging markets. Cinnovex, a version of interferon beta-1a, is produced by CinnaGen in and is widely used there due to high coverage. Other non-originator versions exist, such as those approved in , but biosimilars remain limited in major markets like the and . It is important to distinguish interferon beta-1a products from interferon beta-1b formulations, such as Betaseron (manufactured by ) and Extavia (by ), which are structurally different and not interchangeable with beta-1a brands. In terms of market dominance, Avonex and Rebif hold the largest shares in the and EU, driven by their established efficacy profiles and widespread adoption in relapsing-remitting treatment, while biosimilars like Cinnovex gain traction in emerging markets to improve accessibility.

Economics and access

Interferon beta-1a treatments, such as Avonex and Rebif, carry substantial costs , with annual expenses typically ranging from $90,000 to $150,000 per as of 2025, depending on the specific formulation and dosage regimen, reflecting recent price increases amid limited competition. For instance, a one-month supply of Avonex (prefilled , 30 mcg; 4-pack) is priced at approximately $8,000-8,500, equating to about $96,000-102,000 annually for weekly administration. These high prices reflect the drug's status as a biologic without generic equivalents, contributing to financial barriers for s despite its established role in managing relapsing-remitting . Globally, interferon beta-1a generated approximately $3.5 billion in sales revenue in 2023, positioning it as one of the top drugs, though market share has been declining due to the rise of more convenient oral therapies like and . This shift has led to reduced demand for injectables, with the overall beta market projected to grow modestly but face pressure from competitors, resulting in a global market size of around $3-4 billion. Access to interferon beta-1a remains challenging, particularly in the where high copayments—often exceeding $1,000 monthly without assistance—can deter adherence among commercially insured patients. In contrast, the introduction of biosimilars and generics in regions like the and has reduced costs by 20-30%, making the drug more affordable; for example, domestic versions in offer discounts of 12-74% compared to originators. Insurance coverage helps mitigate these barriers, with interferon beta-1a included under , where about 65% of plans provide reimbursement, though out-of-pocket costs can still be significant post-deductible. Manufacturer-sponsored patient assistance programs, such as Biogen's Copay Program, further support access by reducing eligible patients' costs to as low as $0 for medication and related procedures. From an economic perspective, interferon beta-1a demonstrates cost-effectiveness in delaying progression, with incremental cost-effectiveness ratios ranging from $50,000 to $100,000 per (QALY) gained over 10 years of treatment, based on models comparing it to no therapy or alternative disease-modifying treatments. These ratios underscore its value in for relapsing-remitting , particularly when factoring in long-term reductions in and healthcare utilization.

Research

Investigations in COVID-19

Interferon beta-1a was investigated for treatment due to its established antiviral properties, which enhance host cell resistance to through induction of interferon-stimulated genes, and its anti-inflammatory effects that modulate responses dysregulated in severe infection. Early preclinical studies suggested potential efficacy against coronaviruses, including , by restoring impaired type I signaling in infected cells. The World Health Organization's Solidarity trial, a large-scale phase 3 study initiated in 2020 across multiple countries, evaluated subcutaneous interferon beta-1a in hospitalized patients with COVID-19 but found no significant reduction in mortality (rate ratio 1.16, 95% CI 0.90–1.49) or other clinical outcomes compared to standard care. Similarly, the NIH-sponsored ACTT-3 trial (2020–2021) assessed interferon beta-1a combined with remdesivir in 1,050 hospitalized adults and reported no improvement in time to recovery (median 5 days in both groups) or 28-day mortality (5% vs. 3%). The phase 3 SPRINTER trial (2021–2022) by Synairgen tested inhaled SNG001 (interferon beta-1a) in 620 hospitalized patients requiring oxygen and demonstrated safety but failed to meet primary endpoints of accelerated hospital discharge or recovery, though it showed a non-significant trend toward reduced progression to severe disease. A 2023 review in Frontiers in Medicine analyzed these phase 3 trials (, ACTT-3, and SPRINTER) and concluded that interferon beta-1a missed primary efficacy endpoints across the board, attributing outcomes to challenges in patient timing and disease heterogeneity. Subsequent meta-analyses, including a of 10 randomized trials involving over 2,000 patients, reinforced that interferon beta-1a does not improve survival in hospitalized cases but may slightly reduce progression to intensive care in select cohorts. Emerging evidence from subgroup analyses indicates potential benefits in early-stage, mild-to-moderate , where antiviral effects could limit viral spread before hyperinflammation sets in, but no advantage—and possible harm from exacerbated inflammation—in severe (ARDS) cases. As of 2025, interferon beta-1a is not recommended for routine treatment by major guidelines, including those from the Infectious Diseases Society of America (IDSA) and the (WHO), which prioritize antivirals like nirmatrelvir-ritonavir for high-risk outpatients and emphasize evidence-based therapies over interferons due to lack of consistent benefits.

Emerging applications in other diseases

Research into interferon beta-1a (IFNβ-1a) extends beyond its established role in to explore potential benefits in various other conditions, driven by its immunomodulatory and antiviral properties. In , IFNβ-1a has been investigated as an adjunct therapy in , where a phase II trial demonstrated its ability to induce regulatory changes associated with immune activation, though with reversible toxicities. In infections, IFNβ-1a has shown promise in preventing reactivation in chronic , particularly among non-responders to standard interferon-alpha therapy. A pilot study reported reduced HBV replication in patients treated with IFNβ-1a, suggesting a role in flare prevention through enhanced antiviral signaling. Additionally, preclinical models indicate that type I interferons like IFNβ-1a can suppress HBV at high loads while modulating immune responses to limit progression. For neurodegenerative diseases, early trials have assessed IFNβ-1a in (ALS) and (AD). A in ALS found no significant benefit in slowing progression, with similar rates of functional decline compared to . In contrast, a pilot study in early AD reported IFNβ-1a as safe and well-tolerated over 52 weeks, with exploratory evidence of stabilized cognitive function in a small , warranting further investigation. Emerging preclinical work focuses on advanced systems to improve efficacy and reduce . Long-acting formulations, such as microarray patch technology for subcutaneous IFNβ-1a administration, have demonstrated sustained release and therapeutic equivalence in animal models of autoimmune conditions. approaches, including adeno-associated virus-mediated of the IFNβ gene, have shown antitumor effects in models by enabling localized, prolonged expression to enhance immune surveillance without systemic side effects. De-immunized variants of IFNβ-1a are also under development to minimize formation while preserving bioactivity.

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