COPAXONE: The non interferon based MS treatment you should know about

Copaxone (glatiramer acetate ) is an immunomodulator drug composed of a combination of four amino acids found in myelin basic protein. The exact mechanism of action of glatiramer is unknown. We do know that administration of glatiramer shifts the population of T cells from pro-inflammatory Th1 cells to regulatory Th2 cells that suppress the inflammatory response.

It is also believed that given its resemblance to myelin basic protein, glatiramer may also act as a sort of decoy, diverting an autoimmune response against myelin. This drug has been shown in clinical trials to reduce the number and severity of exacerbations.

On the other hand, the medication is given every day via subcutaneous injections, making it the most frequent of all MS treatment therapies and the injections themselves can have a fairly serious sting to them. The most common side effect of Copaxone is that it can leave fairly itchy/painful welts (lipoatrophy) a skin reactions (taking up to 5 days to disappear).

WHAT IS LIPOATROPHY?

This is the destruction of fat cells in localized areas where the drug has been injected. This looks like a depression in the skin and underlying tissues and is permanent. One study showed that 42% of Copaxone users had some degree of lipoatrophy). This can be avoided by diligently rotating the injection sites.

HOW EFFECTIVE IS COPAXONE?

In a two-year trial a 29% reduction in annual relapse rate was demonstrated. This percentage was pretty much consistent with the results of other CRAB (Copaxone, Rebif, Avonex, Betaseron medications.

However, a 10-year follow-up study seems to indicate that long-term use of this particular drug has very good clinical results. Folks who used it for 10 years had an 80% reduction in relapses. Comparing people who used the medication continuously for 10 years to those who quit after an average of 4.5 years, 91% of the folks that used the medication for 10-years were still walking unaided, versus 50% of the ex-Copaxone users.

In addition, only 38% of the long-term Copaxone users demonstrated worsening of disability, versus 72% 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 the drug wasn't working).

WHAT PATIENTS LIKE YOU SHOULD KNOW AND KEEP IN MIND

Although there is no need for frequent blood tests or white blood cell count, it is highly recommended that you check regularly for any abnormal skin reactions (lipoatrophy).

This MS treatment option is given everyday via subcutaneous injection – using a 0.5 inch and 27 gage needles - The medication needs to be injected into at least a 2-inch pinch. Also, VERY IMPORTANT TIP TO KEEP IN MIND: Injection sites MUST be rotated daily due to the risk of lipoatrophy.

The recommended seven (7) injection areas in your body are:

1. Your Stomach (be careful to avoid about 2” around the navel)

2. Your Right Thigh (about 2” above knee and 2” below groin)
3. Your Left Thigh (about 2” above knee and 2” below groin)
4. Your Left Arm (fleshy part of upper back portion)
5. Your Right Arm (fleshy part of upper back portion)
6. Your Left Hip (fleshy area of upper hip, always below the waist)
7. Your Right Hip (fleshy area of upper hip, always below the waist)

With this information you now know that you will not suffer from any flu-like symptoms nor you will need to do any blood work (Good news!) but this medication stings while being injected, and for about five to ten minutes afterward. A strategy I used when giving myself those not-so-nice injections - when I was giving myself intramuscular injections - is very simple: Think and tell yourself at the time of the injection that you are “sticking it” to MS!

Can’t really explain why this helps but you’ll see that it does!

OTHER POSSIBLE SIDE EFFECTS: ACUTE PANIC-TYPE ATTACKS

They are pretty rare but can be quite 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 then disappear by themselves. Around 10% of all MSers using Copaxone have at least once one of these attacks; usually they take place after several months of being on treatment.

OTHER USEFUL RECOMMENDATIONS YOU SHOULD KNOW:

As of June 2007 the medicine can be stored up to 30 days unrefrigerated (Former storage requirements did not allow more than 7 days at room temperature). Anyway, it is always a good idea to examine syringes before using this medication and do not use if the solution looks a little cloudy.

HOW SIMPLE IS THIS MS TREATMENT?

This MS treatment option comes in prefilled syringes, no mixing or assembly is necessary. The medication should be allowed to come to room temperature (unrefrigerated for 20 to 30 minutes) before injecting.

CONTRAINDICATIONS:

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

PREGNANCY AND BREASTFEEDING RECOMMENDATIONS:

This drug is Category B, meaning it did not cause harm to fetuses in animal studies, but no adequate human studies have been done. Of all of the MS disease-modifying drugs, Copaxone is probably the safest to use during breastfeeding. While there is no published data, any glatiramer acetate 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 while using this drug, 48% stated that they leave the decision on breastfeeding while on the medication up to the patient and about 10% said they would prescribe the MS treatment drug to a breastfeeding mother. This is a decision to discuss with your neurologist, obstetrician and pediatrician.

YOUR DRUG COST:

The drug has a costs between US$ 23,000 and US$ 34,000 dollars a year. (Check exact prices at DestinationRx com

This drug 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 The National MS 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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