THERAPEUTICS

Brands

• Copaxone, Copolymer 1

Generic?

• No

Class

• Immunomodulator

Commonly Prescribed for

(FDA approved in bold)

• For reduction of relapses in patients with relapsing-remitting multiple sclerosis (RRMS)

• Clinically isolated syndromes (CIS)

How the Drug Works

• By modifying the immune processes responsible in part for the development of MS. Glatiramer is a mixture of 4 amino acids thought to approximate the antigenic structure of myelin basic protein (MBP). Experimentally competes with CNS MBP for presentation to T cells

• Induces specific type 2 helper T cells that express anti-inflammatory cytokines

How Long Until It Works

• At least 6 months

If It Works

• Continue to use until RRMS becomes progressive

If It Doesn't Work

• Change to an interferon, reconsider the diagnosis of RRMS, and consider using natalizumab or mitoxantrone, especially for secondary progressive MS

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Acute attacks are often treated with glucocorticoids, especially if there is functional impairment due to vision loss, weakness, or cerebellar symptoms

• Treat common clinical symptoms with appropriate medication for spasticity (baclofen, tizanidine), neuropathic pain, and fatigue (modafinil)

• For patients with RRMS refractory to glatiramer (measured by clinical relapses and MRI accumulation of lesions), consider changing to interferon-β (INFβ), natalizumab, or newer oral agents

Tests

• None required

ADVERSE EFFECTS (AEs)

How the Drug Causes AEs

• Except for injection site reactions, the causes of AEs (i.e., chest pain) seen with glatiramer use are unclear

Notable AEs

• Chest pain, usually immediately postinjection, is common and typically lasts less than a minute, with no associated ECG changes or adverse consequences. This usually starts about 1 month after initiation of treatment

• About 10% of patients experience immediate post-injection reactions, including anxiety, flushing, dyspnea, throat constriction, and urticaria

• Injection site reactions including erythema, induration, pain, pruritus, welts, inflammation, or hemorrhage

• Fever, neck pain, migraine, agitation, anxiety, sweating, and weight gain are slightly more common in treated patients