A lengthy clinical trial testing four medications for multiple sclerosis has found that one of them, glatiramer acetate, marketed as Copaxone, produced fewer relapses as compared with three other interferon drugs tested.1
The 4-year trial, conducted by doctors in Berlin, Germany, was a follow-up investigation to a previous 2-year, non-randomized study testing the same four medications: Copaxone, Rebif, Avonex, and Betaseron.
Current Treatments for MS
Copaxone is a non-interferon, non-steroidal drug designed to reduce brain lesions and the numbers of relapses in people with relapsing-remitting multiple sclerosis. It comes in the form of an injection, administered once a day subcutaneously.2
Rebif is one of three interferon-based drugs for relapsing MS. It works similarly to the natural interferon produced in your body by modulating the activity of immune system cells. It is taken as a subcutaneous injection three times per week.3
Avonex is another interferon-based treatment for relapsing MS. It works by slowing the progression of some disabilities, reducing your number of relapses, and reducing the number of MS lesions in the brain.4 It is taken as an intramuscular injection once per week.5
Betaseron is also a manmade form of interferon used for relapsing-remitting MS by acting as an immune modulator. The drug is delivered as an injection subcutaneously every other day.6
Medicines' Effect on Relapses
In the study, Judith Haas, MD, a neurologist at Jewish Hospital in Berlin, compared the efficacy of the four medications by measuring the numbers of relapses each year for two years prior to initiating therapy, and comparing those to the quantity of relapses at three intervals following the start of treatment. In all, nearly 250 patients participated in the four-year study. The patients were divided into four groups taking one of the treatment options.
At the end of the trial, when Haas and her colleagues compared annual relapse rates prior to treatment, and then up to four years afterward, they found Copaxone outcomes were significantly improved over the interferon treatments. On average, Copaxone therapy reduced relapse rates by nearly three-quarters. By contrast, Rebif showed a 51% reduction in the average number of relapses, Avonex dropped relapse rates by 43% and Betaferon exerted a 38% reduction in the number of relapses, Haas and her team reported.
Medicinal Tolerance
Those on Copaxone also tended to stay on their therapy, and fewer of them dropped out of the study compared to the other treatment groups, the study team reported. "At all time points, the adherence to glatiramer acetate treatment was the highest," wrote the researchers.
None of the treatments had any beneficial impact on the progression of MS in the study, the investigators added.
"These data reinforce and extend the two-year results we recently published in the European Journal of Neurology,7" Haas said. "Importantly, the results at four years remain robust and show significant advantage in terms of reductions in relapse rates with Copaxone compared to the beta interferon treatments."
The ability for patients to stick to this therapy over the long term is also important, she noted.
"This kind of data may assist people living with MS in making an informed decision with their physician about their immunomodulatory therapy," said Haas.
1. Haas J. Open-label study to compare the clinical efficacy of immunomodulatory therapies (glatiramer acetate and interferons) in relapsing-remitting multiple sclerosis: four years of follow up. 15th Meeting of the European Neurological Society. 2005 Jun 18-22. Vienna, Austria.
2. Teva Pharmaceutical Industries. About Copaxone. Available at: http://www.mswatch.com/therapy/section.aspx?SectionId=789eabf5-3a07-4dff-a7ee-0d4ad1381a6d. Accessed August 12, 2005.
3. Serono. Pfizer. Rebif Prescribing Information. Available at: http://www.rebif.com/assets
/pdfs/Rebif_PI.pdf. Accessed August 12, 2005.
4. Biogen Idec. Avonex Efficacy. Available at: http://www.avonex.com/msavProject/
avonex.portal/_baseurl/threeColLayout/SCSRepository/
en_US/avonex/home/considering_ms_treatment/
learn_about_avonex/all_week_effective.xml. Accessed August 12, 2005.
5. Biogen Idec. Avonex Medication Guide. Available at: http://www.avonex.com/msavProject/
avonex.portal/_baseurl/threeColLayout/SCSRepository/
en_US/avonex/includes/footer/prescribe_info_med_guide.xml.
6. Berlex Pharmaceuticals. Betaseron Prescribing Information. Available at: http://www.berlex.com/html/products/pi/Betaseron_PI.pdf. Accessed August 12, 2005.
7. Haas J, Firzlaff M. Twenty-four month comparison of immunomodulatory treatments – a retrospective open label study in 308 RRMS patients treated with beta interferons or glatiramer acetate (Copaxone). Eur J Neurol 2005 Jun;12(6):425-31.
John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include overseeing health news coverage for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.
