r e v i e w Glatiramer in the treatment of multiple sclerosis Syed A r izvi edward Kim Jennifer Moodie Department of Clinical Neurosciences, Brown Medical School, r hode island Hospital, Providence, ri , USA Correspondence: Syed A r izvi Brown Medical School, Director, r hode island Hospital MS Center, 2 Dudley Street, Suite 555, Providence, ri 02905, USA Tel +1 401 444 3799 Fax +1 401 444 3205 email: srizvi@lifespan.org Abstract: Multiple sclerosis (MS) is a disease of the central nervous system with both an inflammatory and degenerative component. The disease primarily affects young adults and results in significant physical and cognitive disability. Several disease-modifying agents are currently used in the management of multiple sclerosis. Glatiramer acetate (GA, Copaxone®, co-polymer 1) is a disease-modifying agent approved for the treatment of relapsing remitting multiple sclerosis. Apart from its unique mode of action, there is evidence pointing toward a possible neuroprotective role. This review will critically discuss GA’s potential mechanisms of action, the results of clinical trials, safety profile, and future directions of treatment. Keywords: multiple sclerosis, disease-modifying agents, glatiramer acetate, clinical trials, MRI, neurodegeneration Introduction Most patients with multiple sclerosis (MS) present with an initial inflammatory phase manifested by relapses and gadolinium-enhancing lesions on magnetic resonance imaging (MRI) followed by a gradually progressive degenerative phase. A minority of patients have the progressive form of the disease from the onset. Even though the etiology and pathogenesis of the disease are largely unknown, several clinical trials have confirmed a favorable response to treatment with immunomodulating and immunosuppressive agents. Several disease-modifying agents are currently available for the treatment of relapsing remitting multiple sclerosis (RRMS). These include interferon-β1a (Rebif® and Avonex®), interferon-β1b (Betaseron®), and glatiramer acetate (Copaxone®). Mitoxantrone (Novantrone®), an immunosuppressant, is used for the treatment of worsening MS. Natalizumab (Tysabri®), a selective adhesion molecule inhibitor, was approved for a short period of time prior to being withdrawn because three patients, two of whom were in MS trials and one of whom was in a Crohn’s disease study, developed progressive multifocal leukoencephalopathy (PML) (Yousry et al 2006). At the time of writing this review, natalizumab is being re-evaluated for approval. However, if approved, it will likely initially be utilized in a select group of patients. All these agents have a marked effect on the inflammatory component of the disease and have been shown to alter the natural history of MS. Unfortunately, effects on the degenerative aspect of the disease have not been consistently demonstrated. Glatiramer acetate (GA) is different from the interferons in having a unique mechanism of action and there is emerging evidence that it may also have an effect on the neuro-degenerative aspect of MS. This article reviews the available data supporting the use of glatiramer acetate in relapsing remitting MS. international Journal of Nanomedicine 2006:1(3) 283–289 © 2006 Dove Medical Press Limited.All rights reserved 283