(FDA approved in bold)

• For reduction of relapses in patients with relapsing-remitting multiple sclerosis. (RRMS)
  
• Clinically isolated syndromes (CIS)

• By modifying the immune processes responsible in part for the development of MS. Glatiramer is a mixture of 4 amino acids thought to approximate the antigenic structure of myelin basic protein (MBP). Experimentally competes with CNS MBP for presentation to T cells
  
• Inducer of specific T 2 helper-type cells that express anti-inflammatory cytokines

• At least 6 months

• Continue to use until RRMS becomes progressive

• Change to an interferon, reconsider the diagnosis of RRMS, and consider using natalizumab or mitoxantrone, especially for secondary progressive MS

• Acute attacks are often treated with glucocorticoids, especially if there is functional impairment due to vision loss, weakness, or cerebellar symptoms
  
• Treat common clinical symptoms with appropriate medication for spasticity (baclofen, tizanidine), neuropathic pain, and fatigue (modafinil)
  
• For patients with RRMS refractory to glatiramer, (measured by clinical relapses and MRI accumulation of lesions) consider changing to interferon-beta, natalizumab, or mitoxantrone. Other options, which are experimental, include monthly methylprednisolone, pulse cyclophosphamide, and other immunosuppressants
  
• Combination therapy may have a role, but has not been proven more effective than monotherapy. There is an ongoing clinical trial looking at combination treatment with avonex and copaxone

• None required