Copaxone for Multiple Sclerosis

For some people with relapsing-remitting MS, it's the best choice

woman getting an injection
simarik/iStockphoto

Copaxone (glatiramer acetate) is a disease-modifying drug for treating relapsing-remitting multiple-sclerosis (RRMS), a form of multiple sclerosis in which symptoms come and go rather than progressively get worse. In studies Copaxone has been shown to be especially effective in preventing the progression of RRMS—better than other treatments, in fact.

It's not clear how Copaxone keeps MS relapses at bay although one theory is based on the fact that the drug's chemical composition is similar to the myelin sheath that surrounds nerve cells and is the target of the immune system response that attacks and destroys it.

The immune system is tricked into attacking the medication instead of the myelin.

One reason Copaxone stands out among RRMS medications is that it isn't made with interferon (a protein that prevents viruses from replicating). Interferon-based drugs have certain side effects that make them a poor choice for some people. Here are some other things to know about Copaxone if you and your doctor are considering adding it to your RRMS treatment regimen.

Itchy Skin and Other Side Effects

Copaxone comes in prefilled syringes and is given by injection using a short slender needle that's inserted subcutaneously—into a 2-inch pinch of skin. The most common injections sites are the abdomen, the back of an arm, the back of a hip, the upper back, or the middle of a thigh. It's a good idea to rotate where the shot is given because it can cause itchy or painful welts that take up to five days to go away. These injection-site reactions often lessen after one to three months of using the drug.

Rotating where shots are given also helps to prevent lipoatrophy, a destruction of fat cells that leaves a permanent depression in the skin and underlying tissues. Most people give themselves the injections except in areas that are hard to reach. A Copaxone shot can sting, but only for a few minutes.

One other side effect of Copaxone worth knowing about is rare but scary: acute panic-type attacks. These reactions can cause 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. About 10 percent of people taking Copaxone experience this at least once, usually after several months of being on treatment.

Who Shouldn't Take Copaxone

Copaxone is safe for most people. The only people who should never take it are those who are sensitive to glatiramer acetate or mannitol (a sugar alcohol). There are no known interactions with other medications.

If you're pregnant or breastfeeding, it's probably safe to take Copaxone. It hasn't been found to harm developing fetuses in animal studies, but there's been no research in human pregnancies, so if you're expecting you and your doctor will need to weigh the small risk before you begin taking Copaxone. Of all the MS disease-modifying drugs, Copaxone is probably the safest to use during breastfeeding. There are no published data, but any Copaxone in breastmilk is probably destroyed in the infant's gastrointestinal tract rather than absorbed.

One exception may be in newborns.

Copaxone comes in two strengths: Twenty-milligram shots to be given daily and 40-milligram injections that are given three times a week. Brand-name Copaxone costs between $6,000 to over $7,500 a month but there are generic forms that tend to be less pricey. Copaxone and its generic forms are covered by most medical insurance too, so if it becomes your MS treatment drug of choice you should have little trouble affording it.

Sources:

Guillermo Izquierdo, Nauri Garcia-Agua Soler, Macarena Rus, and Antonio Jose Garcia-Ruiz, "Effectiveness of Glatiramer Acetate Compared to Other Multiple Sclerosis Therapies." Brain Behav. 2015 Jun; 5(6): e00337.

National Multiple Sclerosis Society. "Copaxone."

US Food and Drug Administration. "FDA Approves First Generic Copaxone to Treat Multiple Sclerosis." Apr 16, 2015.