In addition to the effects of a substance, its side effects play an important role not only in the decision-making process for therapy, but also in the practical application of MS therapy. Therefore, the MS-Docblog is starting a new series of articles. The first episode is about Glatiramer Acetate. In my daily practice, a lot revolves around answering questions about side effects of MS drugs. The package insert is of little help here, as by law all known side effects must be listed and in this context, the weighting of individual points is often lost.
Correctly classify side effects
Neurologists have a very good overview, due to their practical experiences with the individual substances, about which side effects are relevant in patient everyday life and what a patient must know in any case if he decides for a specific substance. Despite the immense “background noise” caused by the countless information on the Internet and social networks about MS therapies, the medical discussion about the side effects of a substance remains the most important decision-making aid for those affected by MS.
Therefore, when planning the DocBlog posts, we came to the conclusion that it would make sense to start a series of articles that summarizes the side effects and problems of the individual active ingredients. In these articles, I will share what I tell my patients in the consultation about a particular active ingredient when it comes to side effects and tolerability. I hope this will provide an interesting added value for the readers of DocBlog.
Since I have already used many lines for the preface, I turn in the first episode to an active ingredient whose side effect profile can be summarized quite quickly – namely Glatiramer Acetate, which is marketed under the trade names Copaxone® and Clift® in Germany.
Reactions at the injection site common
Glatiramer acetate is a mixture of amino acids that is injected subcutaneously. For Copaxone, there is now an approval for the injection of 40 mg on 3 days/week – a real advantage over the previously recommended daily injection of 20 mg. Because the injection and the associated discomfort are certainly the most common and relevant side effect of Glatiramer acetate. The vast majority of patients complain about reactions at the injection site with redness, pain, wheals, and itching, which can usually be well controlled by good skin care of the injection areas and changing the injection sites and after some time is no longer a real problem for most users.
Change in subcutaneous fatty tissue less common
Less common, but not infrequently, local changes in the subcutaneous fatty tissue (probably due to inflammation – panniculitis) develop at the injection sites, leading to an irregularity of the skin structure (the so-called lipoatrophy). This phenomenon is harmless, but can certainly be a cosmetic problem in the bikini area or on the thigh, which should be clarified.
Systemic post-injection reaction very rare
Very rarely, there can be a systemic reaction (the so-called systemic post-injection reaction – SPIR) after injection of Glatiramer Acetate (and at any time during therapy, both after a few days of use and after years of problem-free use). This is a combination of various symptoms such as redness in the face, chest tightness, sweating, palpitations, and feelings of anxiety. The reaction is harmless, it occurs a few minutes after the injection and usually subsides without consequence within 30 min. If a SPIR occurs, one should remain calm and wait – but this behavior presupposes that one was previously informed about the theoretical possibility of a SPIR. Patients who have been missed this are often admitted to a hospital by the called (emergency) doctor. So, very rare, but of practically high relevance.
Otherwise, Glatiramer Acetate is a well-tolerated drug with no further relevant side effects. It has neither noteworthy interactions and interactions with other drugs, nor is there a risk of serious diseases such as cancer. One can communicate this with a clear conscience, because Glatiramer Acetate has been in clinical use for decades without any new safety concerns arising. Glatiramer Acetate can also be used during pregnancy and breastfeeding due to its safety profile, although most women avoid this. But it is another point that underlines the good safety of the active ingredient.
Monitoring measures manageable
For this reason, the monitoring requirements for Glatiramer Acetate are very manageable. A routine laboratory test is recommended at the beginning. In the first year, quarterly laboratory controls are advisable, after that the controls can be significantly extended. Switching from other MS medications or to other MS medications is possible without special precautions and without washout periods.
