Konrad Rejdak1, Zbigniew Stelmasiak2, Paweł Grieb3. 1. Department of Neurology, Medical University of Lublin, Lublin, Poland; Department of Experimental Pharmacology, Medical Research Center. Polish Academy of Sciences, Warsaw, Poland. Electronic address: k.rejdak@umlub.pl. 2. Department of Neurology, Medical University of Lublin, Lublin, Poland. 3. Department of Experimental Pharmacology, Medical Research Center. Polish Academy of Sciences, Warsaw, Poland.
Abstract
BACKGROUND: There has been long-term interest in cladribine as a drug for the treatment of MS. The current study focused on the effect of cladribine on oligoclonal bands (OCB) expression in the CSF in relapsing-remitting MS (RRMS) patients observed over 10 years. METHODS: 29 treatment-naive subjects with RRMS were prospectively enrolled and received induction therapy with subcutaneous parenteral cladribine (at a cumulative dose of 1.8 mg/kg; divided into 6 courses every 5 weeks given for 4-6 days, depending on patients' body weight). Selected patients received maintenance doses in the follow-up period. RESULTS: Isoelectric focusing revealed that 55% of patients did not have OCB in CSF after cladribine treatment as compared to baseline testing when 100% of patients were positive for OCB. There were no significant differences in Expanded Disability Status Scale scores at baseline and at the end of treatment cycle between OCB-positive vs. OCB-negative subgroups. At the last follow-up, OCB-negative patients had lower disability compared to OCB-positive patients (p = 0.03). CONCLUSION: Cladribine-induced immune reconstitution leads to long lasting suppression of intrathecal humoral response, which might be an additional mechanism that enhances the therapeutic effect on disease progression in RRMS patients.
BACKGROUND: There has been long-term interest in cladribine as a drug for the treatment of MS. The current study focused on the effect of cladribine on oligoclonal bands (OCB) expression in the CSF in relapsing-remitting MS (RRMS) patients observed over 10 years. METHODS: 29 treatment-naive subjects with RRMS were prospectively enrolled and received induction therapy with subcutaneous parenteral cladribine (at a cumulative dose of 1.8 mg/kg; divided into 6 courses every 5 weeks given for 4-6 days, depending on patients' body weight). Selected patients received maintenance doses in the follow-up period. RESULTS: Isoelectric focusing revealed that 55% of patients did not have OCB in CSF after cladribine treatment as compared to baseline testing when 100% of patients were positive for OCB. There were no significant differences in Expanded Disability Status Scale scores at baseline and at the end of treatment cycle between OCB-positive vs. OCB-negative subgroups. At the last follow-up, OCB-negative patients had lower disability compared to OCB-positive patients (p = 0.03). CONCLUSION:Cladribine-induced immune reconstitution leads to long lasting suppression of intrathecal humoral response, which might be an additional mechanism that enhances the therapeutic effect on disease progression in RRMS patients.
Authors: Fabian Szepanowski; Clemens Warnke; Gerd Meyer Zu Hörste; Anne K Mausberg; Hans-Peter Hartung; Christoph Kleinschnitz; Mark Stettner Journal: CNS Drugs Date: 2021-10-16 Impact factor: 5.749
Authors: Giancarlo Comi; Amit Bar-Or; Hans Lassmann; Antonio Uccelli; Hans-Peter Hartung; Xavier Montalban; Per Solberg Sørensen; Reinhard Hohlfeld; Stephen L Hauser Journal: Ann Neurol Date: 2020-11-04 Impact factor: 10.422
Authors: Maria T Cencioni; Miriam Mattoscio; Roberta Magliozzi; Amit Bar-Or; Paolo A Muraro Journal: Nat Rev Neurol Date: 2021-06-01 Impact factor: 42.937
Authors: Kottil Rammohan; Patricia K Coyle; Elke Sylvester; Andrew Galazka; Fernando Dangond; Megan Grosso; Thomas P Leist Journal: Drugs Date: 2020-12 Impact factor: 9.546