Copaxone (glatiramer acetate) is an injectable disease-modifying therapy (DMT) used for multiple sclerosis (MS), meaning it is used to help prevent one's condition from worsening. It is different from many other MS drugs of this type in that it may carry fewer of certain side effects known to come with many DMTs.

Indication

Copaxone was approved by the U.S. Food and Drug Administration in 1996 for treating relapsing-remitting multiple sclerosis (RRMS). It's a disease-modifying therapy, meaning it's used to slow the progression of the disease rather than manage the symptoms of it.

RRMS is the most common form of MS, accounting for 85 percent of cases. Its symptoms come and go, rather than progressively getting worse.

Effectiveness

It's not clear how Copaxone keeps MS relapses at bay. One theory is based on the fact that the drug's chemical composition is similar to the myelin sheath that normally surrounds nerve cells. Myelin is the target of the immune system response in MS, which leads to its destruction. Copaxone seems to block T-cells from damaging the myelin, but the exact mechanism is not well known.

In addition, Copaxone is believed to reduce levels of B-cells, which may play a key role in MS. This is an area of ongoing research.

One reason Copaxone stands out among RRMS medications is that it is overall well tolerated, with relatively less side effects as compared to other disease-modifying treatments.

A paper published in 2019 reviewed MS advances and Copaxone's continued use over a 20-year period. In looking at data acquired via magnetic resonance imaging (MRI), the researcher found data suggesting the drug reduces:

Axonal metabolic injury

Tissue damage

Atrophy

Brain-volume loss

Other findings that were cited include:

Copaxone's effectiveness is considered similar to that of interferon beta-1a and interferon beta-1b drugs

Results of short-term studies are conflicting on whether brain-volume loss was improved more with Copaxone or interferon drugs

A long-term study suggested brain-volume loss was reduced more by Copaxone than interferons

The paper's author concluded that, in spite of its age, Copaxone is still widely used as a first-line treatment option, in part due to its effectiveness, the extensive data available, its safety profile, convenient dosing regimen (when compared to similar drugs), and the lack of a necessary monitoring program.

Administration

Copaxone comes in prefilled syringes and is given by injection using a short, slender needle that's inserted subcutaneously into a two-inch pinch of skin. The most common injections sites are the abdomen, the back of an arm, the back of a hip, and the middle of a thigh.

This drug comes in two strengths: 20-milligram (mg) shots to be given daily and 40-milligram injections that are given three times a week.

Most people are able to give themselves their injections unless they're injecting in a spot that's difficult to reach. A Copaxone shot can sting, but only for a few minutes.

Side Effects

Many potential side effects may occur while taking Copaxone. It's important to contact your doctor right away about any side effects you may experience, particularly as the below lists—while extensive—are not exhaustive.

Common

More common side effects of taking Copaxone include:

Anxiety

Chest pain

Cough

Excessive muscle tone

Rapid, pounding, or irregular heartbeat

Joint pain

Lower back or side pain

Neck pain

Difficult or pain urination

Redness of the face or upper body

Rash

Puffiness in your face

Swollen, painful, or tender lymph glands

Trouble breathing

Injection-Site Reactions

Injection site reactions are common in people who take Copaxone for MS, leading to:

Redness

Swelling

Itching

A lump at the injection site

A minority of Copaxone users—approximately 16 percent—experience a more dramatic adverse effect from Copaxone called an immediate post-injection reaction. This reaction happens right after an injection and may cause two or more of the following symptoms:

Flushing (skin warmth and/or redness)

Chest pain

Fast heart rate

Anxiety

Shortness of breath

Throat constriction

Rash

Anyone can experience this reaction, which tends to occur several months after starting treatment with Copaxone. In some people, though, it can occur earlier. This reaction can occur more than once.

While they can be alarming, these symptoms don't have any long-term consequences and typically go away after about 15 minutes. They also don't require treatment.

Even so, the manufacturer of Copaxone advises you to call your doctor right away if you experience a post-injection reaction and to not give yourself another injection until your doctor tells you to resume this drug.

To help avoid an immediate post-injection reaction, try the following as the drug is being administered: Stay relaxed

Sit down

Keep your head upright

Breathe slowly

Have someone with you during an injection, if possible

Less Common

Other less common side effects include:

Agitation

Bloating

Chills

Confusion

Difficulty swallowing

Dizziness or lightheadedness

Fever

Severe, throbbing headache

Genital itching

Muscle aches

Pain during sex

Purple spots or small lumps under the skin

Rapid weight gain

Red streaks on your skin

Shaky, swollen, or tingling limbs, hands, or feet

Throat spasms

Strong urge to urinate

White, curd-like vaginal discharge (may have no or mild odor)

Tightness of the chest

Unusual weight changes

Though rare, the following are also possible:

Bloody urine

Burning or stinging of the skin

Uncontrolled eye movements

Sexual dysfunction

Diarrhea

Difficulty moving

Ear pain

Rapid breathing

Thrush (irritated mouth and tongue)

Decreased appetite

Menstrual pain or changes

Painful cold sores or blisters on the lips, nose, eyes, or genitals

Sensation of movement

Speech problems

Vision problems

Considerations and Contraindications

Copaxone is safe for most people. The only people who should never take it are those who are sensitive to glatiramer acetate or mannitol (a sugar alcohol).

There are no known interactions with other medications.

If you're pregnant or breastfeeding, it's probably safe to take Copaxone. It hasn't been found to harm developing fetuses in animal studies or in reviews of data on more than 7,000 pregnancies.

Of all the MS disease-modifying drugs, Copaxone is generally considered the safest to use during breastfeeding. There are no published data, but any Copaxone in breastmilk is believed to be destroyed in the infant's gastrointestinal tract rather than absorbed. One exception may be in newborns.

If you are pregnant, planning to become pregnant, or breastfeeding, be sure to discuss all medications with your doctor.

Cost

Brand-name Copaxone costs between $6,000 to $7,500 a month or more, but generic forms that tend to be less pricey are on the market. Copaxone and its generic forms are covered by most medical insurance, as well.