Glatiramer acetate: successful desensitization for treatment of multiple sclerosis.
BACKGROUND
Glatiramer acetate is an immunomodulatory drug that is widely prescribed for the treatment of multiple sclerosis. It is frequently associated with local injection site reactions and generalized urticaria. It is also associated with immediate postinjection systemic reactions in approximately 10% of patients. To our knowledge, no desensitization protocols for glatiramer acetate have been published to date.


OBJECTIVE
To evaluate the safety and efficacy of glatiramer acetate desensitization in a series of patients with multiple sclerosis.


METHODS
Six patients with multiple sclerosis and glatiramer acetate-associated local or systemic reactions underwent a 4-hour outpatient desensitization procedure at Cleveland Clinic between 2003 and 2008. Beginning with 20 ng, we administered subcutaneous glatiramer acetate suspension in increasing dosages every 15 minutes. Patient outcomes were monitored by return clinic visit and telephone follow-up.


RESULTS
No episodes of anaphylaxis or serious adverse reactions occurred during or immediately after desensitization. One patient suspended therapy after 14 months due to persistent local injection site reactions. All other patients successfully continued glatiramer acetate therapy.


CONCLUSIONS
Glatiramer acetate offers significant benefit to patients with multiple sclerosis. Our experience suggests that patients who suspend its use owing to local or systemic reactions can be successfully and safely desensitized and can resume medication use. To our knowledge, this is the first report of successful desensitization to glatiramer acetate in patients with multiple sclerosis.
Bains
Sonia N
SN
Department of Allergy and Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Hsieh
Fred H
FH
Rensel
Mary R
MR
Radojicic
Cristine
C
Katz
Hary T
HT
Inamdar
S Rubina
SR
Lang
David M
DM
D000328:Adult; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods; D004342:Drug Hypersensitivity / Q000628:therapy*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000628:therapy*; D005260:Female; D000068717:Glatiramer Acetate; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D009103:Multiple Sclerosis / Q000188:drug therapy*; D010455:Peptides / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D012882:Skin Tests; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D010455:Peptides; D000068717:Glatiramer Acetate