Multiple Sclerosis (MS) Medications (cont.)
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
In this Article
- Introduction to drugs for the treatment of multiple sclerosis
- What are steroids, and which ones are available?
- What are disease modifying drugs, and which ones are available?
- Avonex (interferon beta-1a)
- Rebif (interferon beta-1a)
- Betaseron and Extavia (interferon beta-1b)
- Copaxone (glatiramer acetate)
- Novantrone (mitoxantrone)
- Tysabri (natalizumab)
- Aubagio (teriflunomide)
- Gilenya (fingolimod)
- Lemtrada (alemtuzumab)
- Plegridy (peginterferon beta-1a)
- Tecfidera (dimethyl fumarate or DMF)
- Ampyra (dalfampridine)
Copaxone (glatiramer acetate)
Copaxone is used for reducing the frequency of acute flare ups in patients with Relapsing-Remitting Multiple Sclerosis (RRMS). Glatiramer acetate is a synthetic protein that modifies the immune reactions which may be responsible for MS, but its exact mechanism of action is unknown. Glatiramer acetate can now be administered via subcutaneous injection either once daily or 3 times per week. The new formulation (40 mg/ml) approved in January 2014 has allowed greater patient convenience with administration three times per week compared to daily dosing with the original 20 mg/ml product. Glatiramer acetate comes in prefilled syringes which should be stored in the refrigerator but can be kept at room temperature for up to a week. In clinical trials glatiramer acetate reduced the frequency of relapses and damages to nerves in patients with RRMS. In one such trial, glatiramer acetate was compared to placebo for a period of 2 years using a randomized double blind study design. At 2 years, the relapse rate was significantly lower in the glatiramer treated group at 1.19 versus 1.68 for the placebo group. Furthermore, patients in the placebo group experienced increased disability at 41% versus 22% for the glatiramer group.
Also in a separate study, use of glatiramer acetate was associated with a significant reduction in the formation of new disease-related lesions in the brain on imaging. The most common side effects associated with glatiramer acetate are vasodilation, rash, shortness of breath, chest pain, and injection site reactions including pain, redness, itching, or lump. Some patients report flushing, chest tightness or pain, heart palpitations, anxiety, and trouble breathing after an injection of glatiramer acetate. These symptoms generally appear within minutes after an injection, last a few minutes, and then subside. One advantage of glatiramer acetate treatment is that it has somewhat of a milder side effect profile and does not produce flu-like symptoms, fatigue, or depression which is a significant concern with many of the currently available MS therapies including interferons and steroids. Due to risk of potential harm to the fetus, glatiramer acetate should be used in pregnancy only if clearly needed.
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