Highlights
- •Cladribine (2-chloro-2′-deoxyadenosine) is an adenosine deaminase-resistant purine nucleoside analog with preferential lymphocyte reducing properties acting through the mode of pulsed immune reconstitution.
- •We focused on the effect of cladribine on oligoclonal bands (OCB) expression in the CSF in relapsing-remitting MS (RRMS) patients observed over 10 years.
- •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.
- •At the last follow-up (Year 10), OCB-negative patients had lower disability compared to OCB-positive patients.
- •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.
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.
Keywords
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Article info
Publication history
Published online: October 10, 2018
Accepted:
October 9,
2018
Received:
September 16,
2018
Identification
Copyright
© 2018 Published by Elsevier B.V.
