Author Topic: (Abst.) Lipoatrophy incidence associated w/autoinjection vs. manual subq  (Read 131 times)

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Offline agate

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Presented at the annual CMSC/ACTRIMS conference, May 28-31 in Dallas, TX,  and published in the International Journal of MS Care, May 2014:

(DX65) Incidence of Lipoatrophy Associated with Autoinjection versus Manual Subcutaneous Injections of Glatiramer Acetate

Vu A. Nguyen, Ronald O. Bailey, Carina G. Sprague
Neurology, Riverside Medical Clinic, Riverside, CA


The incidence of lipoatrophy occurring as
a consequence of subcutaneous (SC) injection of glatiramer acetate (GA) has been reported as 2% in the GA package label. The prevalence and severity of lipoatrophy with long-term GA therapy for multiple sclerosis (MS) are largely unknown. The exact cause of lipoatrophy is unknown, but it
is thought to result from an adverse immunologic side effect of the injection. It has also been proposed that local elevated production of tumor necrosis factor–alpha leads to the dedifferentiation
of adipocytes in the SC tissue.


Compare the incidence of lipoatrophy associated with long-term use of autoinjection versus manual SC injection of GA in a clinical practice population of MS patients.


Seventy-three MS patients maintained on GA (mean 36 months) had been given the option of use of autoject 2 versus manual SC injection. Forty patients (54.8%) employed the autoinjection
and the remaining 33 patients (45.2%) opted for manual SC injections.

Both groups were followed with clinical examinations and serial photographic analysis every 3 months. All patients were counseled on proper injection-site rotation and methods on each visit. (The autoject 2 apparatus was provided
through Shared Solutions.)


A total of 46 patients (63%) taking GA developed lipoatrophy over a 3-year interval. Of this number, the overwhelming majority, 35 patients
(76%), developed it with the use of autoject 2.

Lipoatrophy occurred predominantly in women and was noted at multiple injection sites in the same patient. In some patients, lipoatrophy
developed within the first 3 months of injection initiation and was severe enough to necessitate switching to another MS disease-modifying therapy (DMT).

Upon GA treatment discontinuation, lipoatrophy remained permanent.

Serial photographs
of individual patient lipoatrophy will be presented.


Of the side effects of SC GA, lipoatrophy is
the most disfiguring and is invariably permanent.

Our clinical experience with GA showed that 63% of patients developed lipoatrophy. This occurrence (greatest in the autoinjection group) was substantially higher than previously reported
and was often the sole factor prompting patients to switch to another MS DMT.

Our data also suggest that a heightened
risk of lipoatrophy is an inherent autoimmune problem and is not necessarily mitigated by vigilant injection-site rotation irrespective of the methodology of GA administration.


Supported by: None

Disclosure: Vu A. Nguyen, Carina G. Sprague: Nothing to disclose.

Ronald O. Bailey: Teva, Genzyme, Biogen (speaker honoraria
« Last Edit: June 13, 2014, 04:55:16 pm by agate »
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