Lymphadenopathy in patients with multiple sclerosis undergoing treatment with glatiramer acetate

Glatiramer acetate (GA)—formerly known as copolymer 1 or COP-1—has been shown to reduce the frequency of relapses and disease activity and burden as measured by MRI in patients with relapsing-remitting multiple sclerosis (RR-MS).1 The mechanism of action is thought to involve MHC-II blockade2and the induction of a Th2/Th3 cytokine response.3Peripheral blood mononuclear cells from patients with multiple sclerosis and healthy controls proliferate in reponse to GA in vitro.4 Therefore GA seems to have both immunostimulatory and immunomodulatory potential.

In our centre 27 patients with relapsing-remitting or relapsing-progressive multiple sclerosis were treated with 20 mg subcutaneous GA daily for 3 years as part of an open label multicentre study. Safety evaluation and expanded disability status scale (EDSS) rating were performed every 3 months and in the 3rd year every 6 months and when clinical relapses occurred. Relapses were defined according to Poser criteria and annual relapse rates were calculated for the 3 year study duration and a 2 year prestudy period. As two patients reported generalised tender swelling of lymph nodes spontaneously in temporal relation to the beginning of GA injections special attention was paid to the …