Glatiramer: new preparation. No place in multiple sclerosis

(1) Interferon beta-1a is the reference treatment for relapsing-remitting multiple sclerosis. It reduces the frequency of exacerbations and was the first interferon beta shown to delay the onset of disability. (2) Glatiramer, a peptide with certain structural similarities to myelin components, was recently approved for use in this indication. (3) Three randomised double-blind trials lasting a maximum of two years compared glatiramer with placebo. They showed that glatiramer has no impact on the progression of disability. Glatiramer increased slightly the interval between exacerbations: each patient avoided about one exacerbation after two years treatment. But the drug had no effect on the number of patients who experienced exacerbation. Glatiramer has not been compared with interferon beta in clinical trials. (4) The treatment withdrawal rates for adverse effects among patients treated with glatiramer and interferon beta are about the same, although the two drugs have different adverse effect profiles. Most patients using glatiramer have reactions at the injection site. Nearly half the patients given glatiramer have an immediate systemic reaction, and these can be serious. (5) Glatiramer therapy requires daily injections, unlike the more convenient interferon beta (which is given every three days). (6) Glatiramer is no cheaper than interferon beta. (7) In practice, the minor benefits of glatiramer are offset by its adverse effects and less convenient administration. There is currently no place for glatiramer in the treatment of multiple sclerosis.