Treating Multiple Sclerosis When Copaxone Goes Generic



The MD Magazine Peer Exchange "Modifying the Course of Multiple Sclerosis in New Ways: The Latest Advances in Treatment" features a distinguished panel of physician experts discussing key topics in multiple sclerosis (MS) research and management, including the latest insights into MS pathophysiology, new medication options and their application in clinical practice, and more.

This Peer Exchange is moderated by Paul Doghramji, MD, who is a family physician at Pottstown Memorial Medical Center in Pottstown, PA, and medical director of Health Services at Ursinus College, in Collegeville, PA.

The panelists are:

  • Fred D. Lublin, MD, FAAN, FANA, the Saunders Family Professor of Neurology and director of The Corinne Goldsmith Dickinson Center for Multiple Sclerosis, and co-chief editor of Multiple Sclerosis and Related Disorders at the Icahn School of Medicine at Mount Sinai
  • Patricia K. Coyle, MD, professor of neurology, vice chair of Clinical Affairs, and director of MS Comprehensive Care Center
  • Suhayl Dhib-Jalbut, MD, professor and chief of the Department of Neurology at Rutgers, Robert Wood Johnson Medical School

Copaxone (glatiramer acetate injection), which has been available since 1997, is facing patent expiration soon and will be available as a generic. Dhib-Jalbut said that doctors may not have a choice when that happens, being forced to use it because that is what the insurance companies will reimburse due to pricing. Coyle agreed that the decision in the future will most likely be dictated by cost, and the generic will be required to be used first.

This is a complicated molecule to make, said Lublin. Dhib-Jalbut said that a generic version was already approved based on genomic studies and on physical and chemical properties, but “whether that really translates into biological equivalents or not, I’m not sure.”

In terms of vaccinations, Lublin said “in general, we like patients with MS to avoid live vaccines.” But with certain medicines, such as fingolimod and alemtuzumab, patients should be vaccinated against zoster varicella, as well as influenza if that is going around, before initiating treatment, “because once they get on the medication, their immune response is muted.”

In Coyle’s opinion, “I think we’ve been a little bit too scary about vaccinations.” There are good safety data for giving the influenza vaccine, which is a killed vaccine, and “we would certainly give varicella zoster, which is a liver virus vaccine, to an MS patient.” The decision to vaccinate should be determined by a proper risk/benefit analysis. “And I think if you are looking at going on a treatment like alemtuzumab where you’re going to knock out your immune cells for a long time, you want to think beforehand, are there any critically important vaccines that I want to give to this patient before my treatment?”

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