Glatiramer acetate is a disease modifying therapy (DMT) used to treat relapsing remitting multiple sclerosis (RRMS).
DMTs are treatments for people with multiple sclerosis (MS) that can help change the course of your MS by reducing the number of relapses and slowing down the buildup of disability in the long term.
You self-inject glatiramer acetate under the skin, either daily or three times a week depending on the dose. It reduces the number of relapses you may have by about 30% and slows down disability progression.
The brands available on the NHS are called Copaxone and Brabio.
On this page we cover who can take glatiramer acetate, how it works, its benefits and possible side effects.
Glatiramer acetate is used for treating adults with active relapsing remitting multiple sclerosis (RRMS). This means you’re experiencing relapses and/or you have new, active or enlarging lesions on an MRI scan.
Your MS team will assess whether glatiramer acetate is suitable for you and whether you meet the NHS criteria (NHS England) for treatment.
Glatiramer acetate can only be prescribed by a neurologist.
Glatiramer acetate is a man-made (synthetic) medicine made from four amino acids. It is designed to resemble myelin, the protective coating around nerve fibres. In MS, the immune system mistakenly attacks myelin. Glatiramer acetate is thought to act as a chemical decoy (a distraction) which attracts the attention of the immune system attack and diverts it away from your myelin. It is also thought to encourage the production of anti-inflammatory cells, overall calming the immune response and reducing inflammation.
Although glatiramer acetate changes your immune response, it is not thought to suppress the immune system or increase your risk of infections.
The disease modifying therapies (DMTs) for treating relapsing remitting MS (RRMS) are grouped according to how effective they are (efficacy) at reducing the number of relapses you may have.
The therapies are described as:
Glatiramer acetate is considered a moderately effective therapy. In clinical trials, people taking glatiramer acetate had about 30% fewer relapses than people taking placebo (a dummy medicine). MRI scans showed people taking glatiramer acetate had fewer MS lesions. It also slows down the build-up of disability associated with MS. Glatiramer acetate sits at the lower end of the moderately effective category.
Copaxone has been studied extensively since the early 1990s. It has been approved for use on the NHS since 2002. The following study first demonstrated the effectiveness of Copaxone.
In this clinical trial, 251 people with relapsing remitting MS took either Copaxone or placebo for two years. The main measure of the study was the number of relapses per year – Copaxone reduced this by 29% compared to placebo. Over the two-year study, more people taking Copaxone had improved or unchanged disability (measured as a one-point change in EDSS) and more people taking placebo had worsened disability.
Read more about the Copolymer 1 Multiple Sclerosis Study Group clinical trial (PubMed).
The three-times-a-week dosing pattern has been evaluated in the following study.
1,404 people with relapsing remitting MS took either Copaxone three times weekly or placebo for one year. Compared to placebo, Copaxone reduced relapses by 34%. MRI results showed that Copaxone significantly reduced the number of lesions compared to placebo.
Read more about the GALA clinical trial (PubMed).
The following study looked at the long-term effect of taking Copaxone on disability progression.
This study was set up in 2002 to evaluate the long-term benefits of beta interferons and glatiramer acetate. More than 5,000 people taking either Avonex, Betaferon, Copaxone or Rebif were recruited at study centres around the UK. Their disability levels (EDSS) were monitored for 10 years. At the end of the study, changes in disability levels were compared to those recorded from an untreated group.
The study found that the disease modifying therapies (DMTs) delayed the need to use a walking stick by four years.
Read more about the clinical trial results of the Risk Sharing Scheme (PubMed).
Brabio is very similar to Copaxone. They both contain the active ingredient glatiramer acetate. Brabio has been available for use on the NHS since 2018. A clinical trial compared the effectiveness of Brabio to Copaxone.
In this clinical trial, 794 people with relapsing remitting MS took either Brabio or Copaxone for nine months. The main measures of the study were the number of gadolinium-enhancing lesions, annualised relapse rates and EDSS score. The study also assessed the safety and tolerability of Brabio. When compared with Copaxone, Brabio was the same in terms of efficacy, safety and tolerability.
Read more about the GATE clinical trial (PubMed).
We have more information on how medicines are developed.
Before you start taking glatiramer acetate, your MS team will discuss the benefits and possible risks of the therapy with you. Together, you will decide if the benefits outweigh any potential risks based on your individual circumstances. We have more information about starting a disease modifying therapy (DMT) and things to consider.
It's important that you tell your MS team if you have any health problems or are taking other medicines.
You may need to be monitored more closely while taking glatiramer acetate if you have kidney, heart or liver problems.
If you're considering taking glatiramer acetate or any other disease modifying therapy (DMT), your MS team will proactively discuss family planning and the possibility of pregnancy with you where appropriate.
Many women experience fewer relapses during pregnancy, although this varies between individuals. Depending on how active your MS has been before pregnancy, your MS team may recommend continuing glatiramer acetate throughout pregnancy.
Research has shown no safety concerns to mother or baby when glatiramer acetate is taken during pregnancy or while breastfeeding. Glatiramer acetate is also considered safe to take while trying to conceive.
If glatiramer acetate is stopped during pregnancy, it will take several months to reach full effectiveness when it’s restarted and may not reduce relapses during the first few months following pregnancy.
Talk to your MS team as soon as you start thinking about having a baby. If you are trying for a family or you are pregnant, speak to your MS team about whether you should continue to take glatiramer acetate during pregnancy. They’ll likely consider how active your MS has been and talk you through any risks and benefits to help you make an informed decision.
You will usually have an MRI scan before, or shortly after, starting glatiramer acetate. Your MS team might consider routine blood tests to check your blood cell counts, as well as your kidney, liver and heart function. They will also check that you do not have an infection and that you are up to date with your vaccinations.
You self-inject glatiramer acetate under the skin. There are two doses available:
Glatiramer acetate is supplied in single-use, pre-filled syringes that are ready to use. You can inject the ready-filled syringes manually, or you can use them with a reusable auto-injection device.
When using an auto-injector, you insert the pre-filled syringe into the device (which looks a bit like a large pen). Once placed against your skin, you press a button on the device, and it automatically inserts the needle and delivers the medicine. You then remove and dispose of the syringe and keep the auto-injector for your next injection.
There are different reusable auto-injection devices for Copaxone and Brabio syringes. Copaxone syringes should only be used with the CSYNC device, and Brabio with the MyJECT device.
A nurse will show you how to do the injections, discuss the practicalities and offer advice or training and ongoing support if you need it.
The first time you use glatiramer acetate, a nurse or doctor will be with you while you give yourself the injection and monitor you for 30 minutes afterwards.
Glatiramer acetate should be stored in the fridge.
You should always talk to your MS team before stopping glatiramer acetate.
All medicines, including disease modifying therapies (DMTs), can potentially cause side effects.
Some people may not experience side effects from taking glatiramer acetate. Some may find that any side effects ease after the first month or two as their body adapts to the medicine. For others, side effects may persist.
Your MS team will discuss potential side effects of the treatment with you and help you understand your risk. They will also tell you how to manage and report any side effects.
Very common side effects (may affect more than 1 in 10 people) of glatiramer acetate include:
To help manage injection site reactions, it is recommended that you choose a different injection site for each injection and avoid injecting into damaged skin. While injection site reactions are very common in people taking glatiramer acetate, they normally reduce over time. If these reactions continue, talk to your MS team for advice.
Common side effects (may affect up to 1 in 10 people) of glatiramer acetate include:
Glatiramer acetate can cause liver problems, but this is rare. Speak to your doctor straightaway if you experience nausea, loss of appetite, dark-coloured urine, pale stools, yellowing of your skin or the white part of your eye, and bleeding more easily than normal.
Some people may have a reaction after injecting glatiramer acetate. These reactions are uncommon, meaning they may affect between 1 in 1,000 and 1 in 100 people. It’s important to know the difference between an immediate post-injection reaction (IPIR) and a serious allergic reaction (anaphylaxis).
Some people may experience a reaction shortly after an injection. This is called an immediate post-injection reaction (IPIR). It is not an allergic reaction and does not usually cause any lasting harm. Symptoms may include:
What to do: IPIR can feel frightening, but it usually settles on its own within 15 to 30 minutes. If your symptoms do not improve within 30 minutes or become worse, contact your doctor immediately or go to the A&E department of your nearest hospital.
Some people may have a serious allergic reaction to glatiramer acetate shortly after an injection. This can happen even if you’ve been using glatiramer acetate for months or years without any previous problems. Symptoms may include:
What to do: Call 999 immediately or go to the A&E department of your nearest hospital if you experience these symptoms.
For a full list of side effects, see the Patient Information Leaflets for glatiramer acetate (Copaxone or Brabio).
You can report side effects through the Yellow Card scheme. Reporting side effects can make a big difference to other people using the same medicine as you.
People with MS are generally encouraged to have vaccinations which are part of the national vaccinations programme (NHS.UK). Where possible, your MS team will advise you to get relevant vaccinations before you start taking a disease modifying therapy (DMT).
Glatiramer acetate is not thought to affect the way your body responds to vaccination. People taking glatiramer acetate can have live and inactivated vaccines (e.g. the flu jab and Covid-19 vaccine) when needed.
We have more information about vaccinations.
Routine blood tests are generally not needed during treatment. Your MS nurse will arrange regular appointments to review how you are getting on with glatiramer acetate.
If you have a history of kidney or liver problems, you may need to have regular blood tests to check your kidney or liver function. This may include liver blood tests (British Liver Trust).
You will likely have regular MRI scans to check your disease modifying therapy (DMT) is working effectively. Your neurologist will advise how often you should have one. They may recommend having an MRI scan three to six months after starting treatment, then once a year after this to check for MS activity. However, the frequency can vary between MS teams and MRI scans may be done less often than this.
Patient Information Leaflets for other formats available on EMC website.
This information has been developed by the MS Trust Health Information team. Our team produces accurate evidence-based information to help you navigate your every day – working alongside health professionals. We would like to thank the following health professionals for checking the clinical accuracy of this information:
