Last updated on February 28th, 2023 at 02:48 pm
Summary
Glatiramer acetate (GA) has been an injectable workhorse of MS treatment for decades, alongside the interferon-beta preparations. It is moderately effective; only a minority of people with MS receiving GA achieve long-term NEIDA (no evident inflammatory disease activity). Its impact on preventing end-organ damage (brain volume loss) is only modest.
In general, GA formulations are relatively well tolerated in the short-term, the main issues being injection site reactions, occasional flushing reactions with tightness of the chest, swelling of lymph nodes and (rarely) urticaria or hives. However, long-term use of GA leads to lipoatrophy (loss of fatty tissue under the skin). Major advantages are that GA has no monitoring requirements, and it is safe during pregnancy. Adherence has been a problem in the long term, owing to injection fatigue. Given that more effective DMTs are now available, with more favourable attributes, most people with MS now tend to choose non-injectable treatments. Despite this, there is still a role for GA in treating MS, particularly in women who are planning to start or extend their family.
Trade names
Copaxone, Brabio.
Mode of action
Immunomodulatory. GA is often referred to as the DMT with nine or more modes of action, because so many different effects on the immune system have been linked to it. Importantly, none of these immunological changes is associated with immunosuppression.
Efficacy
Moderate.
Class
Maintenance, immunomodulatory.
Immunosuppression
No.
Dosing
- GA-20 mg, prefilled syringe, 20 mg/mL subcutaneous (SC) daily.
- GA-40 mg, prefilled syringe, 40 mg/mL SC three times per week.
Main adverse events
- Injection site reactions (redness, pain, itching, swelling and, rarely, breakdown of the skin). Following prolonged injecting, lipoatrophy and skin necrosis may occur.
- Occasional post-injection reaction (flushing, chest tightness, shortness of breath, palpitations and a rapid heart rate).
Adverse events of special interest
- Swelling of lymph nodes (pseudolymphoma).
- Urticaria or hives.