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Effect of Oral Antihistamine on Local Injection Site Reactions With Self-Administered Glatiramer Acetate

Pardo, Gabriel; Boutwell, Christine; Conner, Jill; Denney, Douglas; Oleen-Burkey, MerriKay

Journal of Neuroscience Nursing: February 2010 - Volume 42 - Issue 1 - p 40-46
doi: 10.1097/JNN.0b013e3181c71ab7

Patients with multiple sclerosis often use injectable medication such as glatiramer acetate or interferons to treat their disease. Subcutaneous injections may be associated with local injection site reactions (LISRs), which can include itching, pain, swelling, or redness. Although not serious, these side effects are bothersome and can have a negative impact on adherence to the therapeutic regimen, particularly in early phases of treatment. This randomized parallel group study of 83 patients with multiple sclerosis who had recently begun glatiramer acetate therapy investigated whether administration of an oral antihistamine (cetirizine hydrochloride; Zyrtec, 10 mg) prior to each daily subcutaneous injection of glatiramer acetate would lower the incidence of LISRs compared with an oral placebo. Data for the outcome measures were derived from patient diaries and from the clinic during the baseline and the treatment periods. The primary outcome measure comparing the number of LISRs at 5 minutes after injection over 2 weeks was slightly but not significantly lower in patients who received cetirizine compared with patients who received placebo. Within-group comparisons showed that there was a significant reduction in mean LISR score from the 2-week baseline period to the 2-week cetirizine treatment period (0, 2, and 5 minutes after treatment). Both groups showed decreases in the average bothersome ratings from the baseline to treatment periods. Use of cetirizine did not affect the type of LISRs that was reported at any time point. There were no safety concerns with the concurrent administration of cetirizine with glatiramer acetate. Because there were no statistically significant differences on the primary end point between patient groups taking cetirizine and those taking placebo prior to glatiramer acetate injections, cetirizine use as a strategy to reduce LISRs in patients on glatiramer acetate therapy cannot be recommended at this time.

Gabriel Pardo, MD MS, is the director of the MS Center of Oklahoma, Mercy's NeuroScience Institute, Oklahoma City, OK.

Christine Boutwell, MD, is a neurologist in Kansas City, MO.

Jill Conner, PhD, is the director of Medical Operations at Teva Neuroscience, Kansas City, MO.

Douglas Denney, PhD, is a professor of psychology at the University of Kansas, Lawrence, KS.

Question or comments about this article may be directed to MerriKay Oleen-Burkey, PhD, at She is the director of Outcomes Research, Teva Neuroscience, Kansas City, MO.

© 2010 American Association of Neuroscience Nurses