What happens if an MS patient stops taking Copaxone?

• More trials are needed investigating the impact of discontinuing Copaxone treatment.
• In patients older than 60 years, discontinuing Copaxone does not appear to make any difference to relapse rates, physical disability, or depression.
• The impact of discontinuing treatment in younger patients is uncertain. In younger people, the disease is more inflammatory, and treatment is likely to have more of an impact.
• Observational studies report that patients with MS who persist in using injectable disease modifying treatments and adhere to the prescribed timing, dosing, and frequency of medication administration have a lower risk of relapse and a better self-reported quality of life than patients who discontinue or are nonadherent.
• A study is underway which is scheduled to wind up in 2021 which may better answer the question.

Copaxone (glatiramer acetate) is a combination of four amino acids that may be used to treat relapsing forms of multiple sclerosis (MS) in adults, such as clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease.

Many people with MS are concerned about coming off their medications, fearing the risk of relapse of their MS symptoms.

What happens if you stop Copaxone?

There have not been many trials that have systematically investigated the impact of stopping disease-modifying treatments, such as Copaxone, on the progression of multiple sclerosis.

Patients with MS who persist in using injectable disease modifying treatments and adhere to the prescribed timing, dosing, and frequency of medication administration have a lower risk of relapse and a better self-reported quality of life than patients who discontinue or are nonadherent.

One study looked at the effects of discontinuing treatment in people who were either on Copaxone or interferon beta-1a. There was no difference in the following outcomes compared to people who remained on treatment:

• Time to clinical relapse
• Number of new lesions or inflammatory lesions on MRI
• Progression of physical disability Inflammatory events.

Another study reported that Copaxone reported the fewest discontinuations based on safety concerns, and it is generally well-tolerated. People did report that the frequency of Copaxone injections meant it was associated with a higher burden than some other medications for MS. The report also reported that many people discontinue Copaxone because of a perceived lack of efficacy. Injectable disease-modifying treatments, such as Copaxone but also interferon beta 1a and 1b, tend to only reduce relapse rates by about one-third and all have a similar impact on disease progression.

A 2018 study that evaluated 600 patients with MS who were older than 60 years found no significant differences in disease outcome between those who stopped therapy (178 patients) compared with those who continued treatment. Only 10% restarted medication, and only one relapsed out of those 178 patients who stopped. There were also no differences in outcomes such as walking speed, hand function, or depression.

It is uncertain the effect that treatment discontinuation has on younger people with MS. In younger people, the disease is overwhelmingly inflammatory, which tends to die down as people get older. Treatment discontinuation in these people may negatively affect patients' clinical outcomes.

DISCOMS is a study that is specifically looking at outcomes of treatment discontinuation in people aged over 55, such as inflammatory disease activity, relapse within 5 years, and lesions on MRI within 3 years of discontinuation. The study is scheduled to end in 2021.

How does Copaxone work in the body?

Experts aren’t sure exactly how Copaxone works in MS but it is thought to modify immune processes that are believed to be responsible for the development of MS.

Research has shown that after administration of glatiramer, glatiramer-specific suppressor T-cells are induced and activated in the peripheral nervous system. Although glatiramer is thought to modify the immune system response to MS, it does not appear to modify naturally occurring immune responses, although this has not been systematically evaluated.

Glatiramer acetate is a combination of the acetate salts of four naturally occurring amino acids: L-glutamic acid, L-alanine, L-tyrosine, and L-lysine. These amino acids resemble the myelin protein surrounding nerve fibers and are thought to act as a decoy to divert an immune attack away from your myelin.

Copaxone reduces the frequency of relapses, and some studies have reported a delay in the progression of the disease.

How long does it take Copaxone to work?

Copaxone starts working from the first injection; however, its effects may not be obvious for several months. Most people report it takes six to nine months before an effect is noticed. In some people, it may take longer.

Copaxone is considered a long-term treatment for MS and it has been available for the treatment of MS for more than ten years. Copaxone has been shown to significantly reduce the number of relapses in people with MS.