Practical Guidance on the Use of Cladribine Tablets in the Management or Relapsing Multiple Sclerosis: Expert Opinion from Qatar DOI Open Access
Dirk Deleu, Beatriz Canibaño,

Osama Elalamy

et al.

Degenerative Neurological and Neuromuscular Disease, Journal Year: 2023, Volume and Issue: Volume 13, P. 81 - 88

Published: Dec. 1, 2023

The increasing availability of high-efficacy disease-modifying therapies (DMT) for the management relapsing multiple sclerosis (RMS) has increased potential individualised patient but added complexity to design treatment regimens. long-term application immune reconstitution therapy (IRT) is supported by an database real world studies that have important information on safety and efficacy this approach. Cladribine tablets (CladT) IRT given as two annual short courses treatment, following which a majority patients then demonstrate no significant MS disease activity over period years. Whether, how, treat beyond first years remains matter debate, clinical evidence accumulates. We, group neurologists who manage people with RMS in Qatar, provide our expert consensus recommendations CladT based experience last 5 These include pragmatic 3 4 (ie up four dose CladT), or without subsequent We believe will help ensure optimal CladT-based IRT, benefit achieving prolonged periods free both symptoms burden regular applications immunosuppressive DMT.

Language: Английский

Magnetic Resonance Imaging Evidence Supporting the Efficacy of Cladribine Tablets in the Treatment of Relapsing-Remitting Multiple Sclerosis DOI Creative Commons
Rosa Cortese,

Giovanna Testa,

Francesco Assogna

et al.

CNS Drugs, Journal Year: 2024, Volume and Issue: 38(4), P. 267 - 279

Published: March 15, 2024

Numerous therapies are currently available to modify the disease course of multiple sclerosis (MS). Magnetic resonance imaging (MRI) plays a pivotal role in assessing treatment response by providing insights into activity and clinical progression. Integrating MRI findings with laboratory data enables comprehensive assessment course. Among MS treatments, cladribine is emerging as promising option due its selective immune reconstitution therapy, notable impact on B cells lesser effect T cells. This work emphasizes MRI's contribution treatment, particularly focusing influence tablets outcomes, encompassing from real-world studies. The evidence highlights that cladribine, compared placebo, not only exhibits reduction inflammatory markers, such T1-Gd+, T2 combined unique active (CUA) lesions, but also mitigates brain volume loss, within grey matter. Importantly, reveals early action reducing CUA lesions first months regardless patient's initial conditions. mechanism action, sustained efficacy beyond year 2, onset collectively position component therapeutic paradigm for MS. Overall, MRI, along measures, has played substantial showcasing effectiveness addressing both neurodegenerative aspects

Language: Английский

Citations

4
Real-world therapy management of patients with multiple sclerosis receiving cladribine tablets beyond year 4 – Results from a German cladribine cohort DOI Creative Commons
Markus C. Kowarik,

Michael Ernst,

Lara Woitschach

et al.

Multiple Sclerosis and Related Disorders, Journal Year: 2024, Volume and Issue: 88, P. 105704 - 105704

Published: June 7, 2024

Language: Английский

Citations

3
Additional Cladribine Tablets Treatment Courses in Multiple Sclerosis Patients. A Retrospective Observational Study in Latin American Countries DOI
Berenice Silva, María Célica Ysrraelit, Gisela Zanga

et al.

Multiple Sclerosis and Related Disorders, Journal Year: 2025, Volume and Issue: 94, P. 106275 - 106275

Published: Jan. 14, 2025

Language: Английский

Citations

0
First insights into the safety and effectiveness of additional courses with cladribine tablets under real-world conditions DOI
Christoph Kleinschnitz, Jelena Škuljec, Markus C. Kowarik

et al.

Multiple Sclerosis and Related Disorders, Journal Year: 2025, Volume and Issue: unknown, P. 106398 - 106398

Published: March 1, 2025

Language: Английский

Citations

0
Disease activity 4.5 years after starting cladribine: experience in 264 patients with multiple sclerosis DOI Creative Commons
Kimberley Allen‐Philbey, Stefania De Trane, Amy MacDougall

et al.

Therapeutic Advances in Neurological Disorders, Journal Year: 2023, Volume and Issue: 16

Published: Jan. 1, 2023

Cladribine is an effective immunotherapy for people with multiple sclerosis (pwMS). Whilst most pwMS do not require re-treatment following standard dosing (two treatment courses), disease activity re-emerges in others. The characteristics of developing re-emerging remain incompletely understood.To explore whether clinical and/or paraclinical baseline characteristics, including the degree lymphocyte reduction, drug dose and lesions on magnetic resonance imaging (MRI) are associated activity.Service evaluation undergoing subcutaneous cladribine (SClad) treatment.Demographics, clinical, laboratory MRI data receiving two courses SClad were extracted from health records. To assess associations predictor variables activity, a series Cox proportional hazards models was fitted (one each variable).Of n = 264 236 received included analysis. Median follow-up 4.5 years (3.9, 5.3) first, 3.5 (2.9, 4.3) last administration. Re-emerging occurred 57/236 (24%); 22/236 further doses (SClad or tablets) at 36.7 months [median; interquartile range (IQR): 31.7, 42.1], other immunotherapies 18.9 (13.0, 30.2) after their second course SClad, respectively. Eligibility based 29, relapse 5, both 13, elevated cerebrospinal fluid neurofilament light chain level 3, deterioration unrelated to 4 3. Only 36/57 those eligible additional had reduced course. Association detected between (i) high (ii) low SClad.Re-emerging SClad.

Language: Английский

Citations

6
Cladribine tablets in people with relapsing multiple sclerosis: A real-world multicentric study from southeast European MS centers DOI
Ivan Adamec, Gregor Brecl Jakob, Cecília Rajda

et al.

Journal of Neuroimmunology, Journal Year: 2023, Volume and Issue: 382, P. 578164 - 578164

Published: July 27, 2023

Language: Английский

Citations

4
Holistic, Long-Term Management of People with Relapsing Multiple Sclerosis with Cladribine Tablets: Expert Opinion from France DOI Creative Commons
Jonathan Ciron, Bertrand Bourre,

Giovanni Castelnovo

et al.

Neurology and Therapy, Journal Year: 2024, Volume and Issue: 13(3), P. 503 - 518

Published: March 15, 2024

Cladribine tablets (CladT) has been available for therapeutic use in France since March 2021 the management of highly active relapsing multiple sclerosis (RMS). This high-efficacy disease-modifying therapy (DMT) acts as an immune reconstitution therapy. In contrast to most DMTs, which act via continuous immunosuppression, two short courses oral treatment with CladT at beginning years 1 and 2 provide long-term control MS disease activity responders treatment, without need any further pharmacological several years. Although labelling does not guidance beyond initial courses, real-world data on from registries previous clinical trial participants patients treated routine practice indicate that is controlled a period this time substantial proportion patients. Moreover, experience provided useful information how initiate manage CladT. article we, group expert neurologists France, recommendations initiation DMT-naïve patients, switch existing DMTs continuing activity, during first finally, or 3, 4 after initiating We believe optimisation its will maximise benefits especially early course when suppression focal inflammation CNS priority limit progression.

Language: Английский

Citations

1
Cladribine tablets in Relapsing-Remitting Multiple Sclerosis preferentially target B-cells DOI

Francesca Ammoscato,

Mohammad Aboulwafa,

Justyna Skonieczna

et al.

medRxiv (Cold Spring Harbor Laboratory), Journal Year: 2024, Volume and Issue: unknown

Published: March 29, 2024

Abstract Recently it has been shown that treatments targeting B cells in multiple sclerosis (MS) are effective controlling disease activity. contribute to the pathogenesis of MS via antigen presentation, T cell activation, and antibody production. In chronic progressive cladribine trial, some patients treated with had a significant decline oligoclonal band number. However, mode action tablets (CladT) on peripheral immune its biological activity within CNS remains be determined further. The CladB study is longitudinal prospective investigation CladT treatment relapsing-remitting (RRMS). Blood was sampled at Day 0, 1, 5, then once week for 8 weeks, fortnightly up 24 month till 96 weeks cells. This compared historical cohort alemtuzumab samples one month. Paired cerebrospinal fluid (CSF) blood were also taken 48 after initiating Kappa Lambda-free light chain (кFLC, λFLC) index, bands (OCBs), immunoglobulin indices, inflammatory mediators neurofilament (NfL). Participants underwent clinical magnetic resonance imaging brain assessments. Ten participants (3 male, 7 female, mean age 35.9 ± 10.5 (SD) Expanded disability Status Scale 2.5 (range 0-6) baseline enrolled. cells, particular memory heavily depleted by CladT. Alemtuzumab, conversely rapidly both Although still present, reduction OCB numbers observed 4/10 кFLC index reduced from 164.5 227.1 71.3 84.7 (p=0.002) 64.4 67.3 (p=0.01). coincided IgG [1.1 0.5 baseline, 0.8 0.4 (p=0.014) 0.3 (P=0.02) weeks] CSF CXCL-13 [88.6± 68.4 pg/mL, 39.4 35.2 mg/mL (p=0.037) 19.1 11.7pg/ml (p=0.027)]. NfL levels only conclusion, our supports view works primarily depleting B-cells antibody-secreting precursors RRMS leading sustained effects intrathecal production total associated B-cell chemoattractant CSF.

Language: Английский

Citations

1
Practical Recommendations from the Gulf Region on the Therapeutic Use of Cladribine Tablets for the Management of Relapsing Multiple Sclerosis: Impact of the Latest Real-World Evidence on Clinical Practice DOI Creative Commons
Bassem Yamout, Raed Alroughani, Jihad Inshasi

et al.

Neurology and Therapy, Journal Year: 2024, Volume and Issue: 13(5), P. 1321 - 1335

Published: Aug. 3, 2024

Cladribine tablets (CladT), like alemtuzumab, acts as an immune reconstitution therapy. However, CladT is administered orally (alemtuzumab given by infusion) and without the potential for serious side effects that limit therapeutic use of alemtuzumab in multiple sclerosis (MS). Treatment with CladT, initially short courses treatment 1 year apart, provides years freedom from MS disease activity responders to treatment. The appearance mild or moderate after initial 2 may prompt careful follow-up a further course depending on nature individual circumstances. severe requires switch alternative high-efficacy disease-modifying (DMT). accumulating data CladT-treated people real-world studies, including those durations extending beyond treatment, have demonstrated long-term good proportion patients. This clinical experience has also confirmed generally safe well tolerated. best time prescribe DMT subject debate, evidence earlier versus later such agents provide more effective protection disability progression. High-efficacy DMTs traditionally been reserved high presentation breakthrough one DMTs, per current product labels. latest studies suggests DMT-naïve patients, shorter duration.

Language: Английский

Citations

1
Practical recommendations on treatment of multiple sclerosis with Cladribine: an Israeli Experts Group‏ Viewpoint DOI
Panayiota Petrou, Anat Achiron,

Esther Ganelin Cohen

et al.

Journal of Neurology, Journal Year: 2023, Volume and Issue: 270(11), P. 5188 - 5195

Published: July 12, 2023

Language: Английский

Citations

2