Is Copaxone for Multiple Sclerosis Right for You?

woman getting an injection

This article is not about why disease-modifying therapy like Copaxone is a good idea, rather I have tried to put together as many facts as I could about the drug in plain language. Why? When I was trying to choose my treatment, I know that it was hard to find information about these drugs that was from a neutral source.

Having set my goal as giving you the information that I was interested in when I was trying to make a decision about which MS treatment to start, I will start with the bottom Line—summarizing my take on Copaxone.

I have more detailed information which follows.

Bottom Line: All of the CRAB drugs (Copaxone, Rebif, Avonex, Betaseron) are pretty much equally effective overall, offering a one-third reduction in relapses when compared to a placebo over two years in people with relapsing-remitting MS (RRMS). People with RRMS usually make their treatment decisions based on their doctor's advice and experience with similar patients, as well as concerns about convenience, side effects, and cost.

Copaxone (glatiramer acetate) is a different formulation than the other CRABs, which are interferon-based. Therefore, it has different side effects. It does NOT have the flu-like symptoms, possible links to depression, potential liver damage or effects on white blood cells or thyroid function of the interferons. This makes Copaxone a popular choice for people working full-time, mothers of young children or other people who cannot afford downtime due to side effects.

However, Copaxone is injected every day, the most frequent of any MS therapy, and the injections themselves can have a fairly serious sting to them. They also can leave fairly itchy/painful welts (which can take up to 5 days to go away), which is the most common side effect. Copaxone also can cause lipoatrophy, a destruction of fat cells in localized areas where it has been injected.

This looks like a depression in the skin and underlying tissues and is permanent.

Some doctors are reluctant to start people with more aggressive RRMS on Copaxone, as it seems to take six to nine months to reach full effectiveness.

Copaxone for Relapsing-Remitting MS (RRMS)

Effectiveness: Pretty similar to all of the CRABs—a 29 percent reduction in annual relapse rate in a two-year trial. However, a 10-year follow-up study seems to indicate that long-term use of Copaxone has very good clinical results.

People who stayed on Copaxone for 10 years had an 80 percent reduction in relapses (in other words, they went from having one and a half relapses per year to one relapse every five years). Comparing people who used Copaxone continuously for 10 years to those who quit after an average of four and a half years, 91 percent of the 10-year Copaxone were still walking unaided, versus 50 percent of the ex-Copaxone users.

In addition, only 38 percent of the long-term Copaxone users demonstrated worsening of disability versus 72 percent of those who had quit. It should be mentioned that a large number of people dropped out of this study, so the results could be pretty skewed in favor of Copaxone (as the people who dropped out may have done so because they felt that Copaxone wasn't working).

Necessary Monitoring: There is no need for routine laboratory monitoring. However, patients should routinely check injection sites (as well as have their doctor check) for lipoatrophy.

Injection Considerations: Copaxone is given daily as a subcutaneous (under the skin) injection, usually done by the patient themselves or a family member. The needle is shorter than for intramuscular therapies (half an inch versus one to one and a quarter inches) and is 27 gauge (which is pretty darn thin).

However, a subcutaneous injection requires some fat to be injected into at least a two-inch pinch. Also, Copaxone injections MUST be rotated daily, due to the risk of lipoatrophy, so there must be enough fat to do this on the seven different injection areas.

Because two of these injection areas are the backs of the arms, the patient must either have someone help them, become accustomed to using the Autoject device, or get pretty creative in how they are going to reach the backs of their arms and find enough fat without being able to pinch it (since the other hand is already holding the syringe). Copaxone stings while being injected and for about five to 10 minutes afterward.

Side Effects and Lifestyle: The most common side effects of Copaxone are:

  • Injection-site reactions: These include burning, itching, and swelling. They tend to lessen after the patient has been on Copaxone for one to three months.
  • Lipoatrophy: This is a localized loss of fat which is fairly common (in one study, 42 percent of Copaxone users had some degree of lipoatrophy). This can be avoided by diligently rotating the injection sites.
  • Acute Panic-Type Attacks: These are a pretty rare side effect of Copaxone, but can be pretty scary. These reactions involve flushing, chest pain, heart palpitations, anxiety, constriction of the throat and/or trouble breathing. These symptoms happen within minutes of an injection, last about 15 minutes, and go away by themselves. They happen in about 10 percent of patients at least once, usually after several months of being on treatment.

History: Copaxone has been available since 1996.

Storage: As of June 2007, Copaxone can be stored up to 30 days unrefrigerated (which is a change to the former storage requirements of no more than 7 days at room temperature). Always examine syringes before using and do not use if the solution looks cloudy.

Ease of Use: Copaxone comes in prefilled syringes, not requiring mixing or assembly. They should be allowed to come to room temperature (unrefrigerated for 20 to 30 minutes) before injecting.

Contraindications: Copaxone is contraindicated in patients with known hypersensitivity to glatiramer acetate or mannitol (a sugar alcohol). There are no known interactions with other medications.

Pregnancy: Copaxone is Category B, meaning it did not cause harm to fetuses in animal studies, but no adequate human studies have been done.

Breastfeeding: Of all of the MS disease-modifying drugs, Copaxone is probably the safest to use during breastfeeding. While there is no published data, any Copaxone in breastmilk is probably destroyed in the infant's gastrointestinal tract and not absorbed, except perhaps in neonates. In a survey of 147 women neurologists in the United States and Canada, 13% stated that they discourage breastfeeding with Copaxone, 48% stated that they leave the decision on breastfeeding while on Copaxone up to the patient and about 10% said they would prescribe Copaxone to a breastfeeding mother. This is a decision to discuss with your neurologist, obstetrician, and pediatrician.

Cost: Copaxone costs between 23,000 and 34,000 dollars a year. (Check exact prices at Copaxone is covered by most medical insurance carriers. The patient support program, Shared Solutions, can help you determine if your insurance plan covers Copaxone. The website states: If you do not have insurance or if you need help paying for Copaxone, Shared Solutions can refer you to other financial assistance programs. To speak with someone at Shared Solutions, call 1-800-887-8100.Your doctor's office or the local chapter of the National Multiple Sclerosis Society should also be able to assist you in determining financial options for affording treatment. More Information: Copaxone is made by Teva Pharmaceutical Industries Ltd. For more information, visit the Copaxone website, or call Shared Solutions at 1-800-887-8100.


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