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.
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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 about 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 down time 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.
More Detailed Information on Copaxone
Type of MS and Severity: Copaxone is for relapsing-remitting MS (RRMS).
Effectiveness: Pretty similar to all of the CRABs -- a 29% 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% reduction in relapses (in other words, they went from having 1.5 relapses per year to one relapse every 5 years). Comparing people who used Copaxone continuously for 10 years to those who quit after an average of 4.5 years, 91% of the 10-year Copaxone 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 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 (.5 inch versus 1 to 1.25 inches), and is 27 gauge (which is pretty darn thin). However, a subcutaneous injection requires some fat to be injected into at least a 2-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 ten 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 localized loss of fat, which is fairly common (in one study, 42% 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% of patients at least once, usually after several months of being on treatment.