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MS Drug Gives Patients Options

Champion pool player David Krolick found himself behind the eight ball six years ago when he was diagnosed with multiple sclerosis (MS).

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Until doctors confirmed his illness, Krolick, 52, of Albuquerque, New Mexico, constantly battled fatigue, was never able to work more than a couple hours at a time without stopping to take a nap, and could not balance on one leg to sink one of his skillful pool shots.

Krolick's neurologist recommended he take the drug Copaxone to reduce MS relapses. Copaxone, developed by the Israeli company Teva Pharmaceuticals, has been available in the United States since 2001.

"Very slowly, over a period of many months, I got a little bit stronger," Krolick said. "I have fewer issues with fatigue. In several ways I'm actually better than I was. I attribute that to the medication."

Krolick is one of hundreds of patients with multiple sclerosis, a debilitating syndrome, who see better results with Copaxone than with interferon therapy--a protein that, when injected into the body, forces healthy cells to produce enzymes that counteract infections.

Different Mechanism

In its June issue, The European Journal of Neurology published the results of a study that followed for 36 to 42 months 85 MS patients who had switched from Avonex, an interferon medication, to Copaxone. The result was fewer side effects.

David Birnbaum, a doctor at the Minneapolis Clinic of Neurology who was not part of the study but prescribes Copaxone for his patients, said the drug is an ideal alternative for MS patients who don't respond well to interferon treatment, which often results in side effects--including headaches, fever, chills, and other flu-like symptoms--that usually subside over time, Birnbaum said.

"A small number of people never adapt to interferon," Birnbaum said, adding doctors often have to monitor patients' blood and check for liver toxicity.

Teva Pharmaceuticals Vice President Rivka Riven Kreitman said if patients fail one type of interferon treatment for MS, the likelihood of seeing positive results with another is slim.

"The importance of this study is that if patients don't want to do interferon therapy, they do have an option," Kreitman said.

Dual Benefits

Copaxone has a second benefit, Kreitman said. Upon injection, the drug creates its own T cells, which are anti-inflammatory and can cross the blood-brain barrier, thus treating MS's inflammatory and neurodegenerative symptoms.

Krolick said he chose Copaxone over interferon drugs not only because his doctor recommended it, but also because of its ease of use and fewer side effects. The interferon drugs, he said, "make you feel like you have the flu all the time."

In addition, the daily injections of Copaxone are subcutaneous, not intermuscular, and therefore less painful. "The idea of jamming a needle an inch and a half into my muscle did not appeal to me," Krolick said.

He takes Copaxone every night before he goes to bed, alternating between the front of his thighs, his abdomen, and his hips.

Multiple Responses

How a patient responds to Copaxone varies, Birnbaum said, because MS has multiple causes. "The patterns of tissue destruction [from MS] are going to be different in different people," he said.

Copaxone's side effects include a burning or bump at the injection site, as well as localized redness and swelling. Occasionally, injecting Copaxone into a small vein will result in a rush of Copaxone, which can cause heart palpitations, Birnbaum said, but "it's not an allergy. For most people who take it, it doesn't happen at all," he said.

Injecting Copaxone over a period of time can result in toughness of the skin. Doctors advise people to move the injection site around so the problem is kept to a minimum, Birnbaum said.

"It's a totally different kind of a drug," Birnbaum said. "A person who's not a responder to interferon might have a better response [to Copaxone]."

Mat Herron (mat.herron@gmail.com) is a freelance writer in Louisville, Kentucky.

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