A revolutionary research study hints at the evidence that COPAXONE® (glatiramer acetate injection) may offer protection from axonal injury and induced neuronal metabolic recovery in patients with relapsing remitting multiple sclerosis (RRMS).
COPAXONE® (glatiramer acetate injection) is a selective MHC class II modulator. COPAXONE® is indicated for the reduction of the frequency of relapses in relapsing remitting multiple sclerosis. The most common side effects of COPAXONE® are redness, pain, swelling, itching, or a lump at the site of injection, weakness, infection, pain, nausea, joint pain, anxiety, and muscle stiffness.The research study which was a pilot study comprises 18 RRMS patients using brain imaging techniques. It was found that COPAXONE® produced significant increases in n-acetylaspartate/creatine (NAA/Cr) ratio, an indicator of neuron and axon integrity, compared to four untreated control patients after one year of treatment. This increase was maintained at two years of follow-up. Additionally, patients treated with COPAXONE® showed a significant 50 percent reduction in relapses compared to baseline (p<0.001) while relapse rate in the untreated group remained unchanged.
“The increases in NAA/Cr ratios with COPAXONE® suggested sustained beneficial effects on cerebral axonal recovery. We believe this indicates a potential for improved electrical conduction pathways in the brain, supporting the emerging concept that, centrally, COPAXONE® may be acting as a neuroprotective agent,” said Omar Khan, M.D., associate professor of neurology and director of experimental therapeutics/clinical research, Multiple Sclerosis Center, Wayne State University. “This data is of critical significance because axonal transection is a well-known feature of active MS lesions and represents an irreversible stage of the disease process,” said Dr. Khan.
Twenty-two treatment-naïve RRMS patients were included in the study. Baseline neurological assessments and magnetic resonance spectroscopy imaging (MRSI) scans were performed. Eighteen patients were treated with COPAXONE® (glatiramer acetate injection) and followed for two years with neurological assessments every six months and MRSI scans annually. Due to needle phobia, four patients elected to remain untreated and were followed using the same assessment and MRSI schedule. NAA/Cr ratio measurements were obtained in a selected volume of interest (VOI) within the brain and included normal-appearing white matter (NAWM) within the VOI.
In the COPAXONE® group, the NAA/Cr levels within the VOI were significantly increased by 9.1 percent at year one and by 10.7 percent at year two, compared to baseline (p=0.03 for both assessments). Conversely, in the untreated group, a 5.5 percent decrease in NAA/Cr levels was observed in the VOI at year one (p=0.04) and an 8.9 percent decrease at year two (p=0.03). COPAXONE® patients also demonstrated a 5.4 percent and 7.1 percent increase in NAA/Cr ratios within the NAWM at years one and two, respectively (p=0.04 for both). Untreated patients had a two percent (p=n.s.) and 8.2 percent (p=0.03) decrease in NAA/Cr ratios within the NAWM at year one and two, respectively.
“We recognize our study contains limitations, such as the number of patients, open-label design, and the MRS technique of evaluating NAA levels,” stated Dr. Khan. “However, our recently presented three-year data showed sustained improvements in NAA/Cr ratios which clearly demonstrated a long-term clinical benefit and showed that COPAXONE® treatment may lead to neuronal recovery,” said Dr. Khan.
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