Glatiramer acetate and the glatiramoid class of immunomodulator drugs in multiple sclerosis: an update.

IMPORTANCE OF THE FIELD: MS is a chronic progressive inflammatory and neurodegenerative disease associated with autoimmune dysregulation. Glatiramer acetate (GA), a complex polypeptides mixture and first member of the glatiramoid class, is a first-line therapy for relapsing MS. New glatiramoids are under development. AREAS COVERED IN THIS REVIEW: Studies from a PubMed search with terms 'glatiramer' and 'glatiramoid' were evaluated, focussing on studies conducted between 2007 and 2010. WHAT THE READER WILL GAIN: We review newly discovered GA effects on innate and acquired immunity and results of recent clinical studies. GA delays conversion from a clinically isolated syndrome to definite MS and has clinical benefits comparable to those of IFN-beta drugs, but is more cost-effective and improves quality of life. Preclinical studies of protiramer, a higher molecular mass glatiramoid, showed unexpected toxicity in animals, resulting in discontinuation of drug development. TAKE HOME MESSAGES: GA is a cost-effective, safe and efficacious MS treatment with pleiotropic immunomodulation activity, is best prescribed early and may safely enhance outcomes when used with other immunomodulators. Protiramer experience indicates the potential for unexpected toxicity associated with new glatiramoids. The safety, efficacy and immunogenicity of new glatiramoids must be evaluated thoroughly.