ProfK launched ChariotMS last week. Case reports of COVID-cladribine

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There has not been as much information about COVID-19 and oral cladribine as has occurred with anti-CD20. In view of the launch of ChariotMS by ProfK. This case report is welcome news in that both people who developed COVID were not hosptialised and recovered. They were relatively young and may be expected to recover but the fact that they had COVID shortly after treatment when the depleting effects would be maximal bodes well and the fact that the person could make an antibody response when B cells should be depleted is encouraging

Preziosa P, Rocca MA, Nozzolillo A, Moiola L, Filippi M. COVID-19 in cladribine-treated relapsing-remitting multiple sclerosis patients: a monocentric experience. J Neurol. 2020 Nov 20. doi: 10.1007/s00415-020-10309-4.

This talks about two people out of 56 in the practice on cladribine. One person appeared to be infected in the first week after the first set of tablets. They were not SARS-CoV-2 PCR tested and they didn’t make an antibody response when tested 4 months later. The second person was also not tested for virus but positive for antibody 2 months later

The second RRMS patient is a 40-year-old female with a disease duration of 13.4 years, moderate disability (EDSS=3.5), and no comorbidities. She started cladribine on February 13th 2020 and underwent the second week of the first treatment course from March 5th 2020. On March 30th, she developed fever (<37.8°), anosmia (lack of smell), ageusia (loss of taste), cough, fatigue, and bone/joint pain. Serology for SARS-CoV-2 performed in May 2020 was positive. Blood examinations both before and after COVID-19 disease were normal.

COI: multiple

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5 comments

  • Definitely good news for someone who is on cladribine (6 months since final year 2 dose). Also good news that you can develop antibodies. Neuro appointment on Friday, going to ask him about vaccines and whether I can get serology done after vaccines to see if I have Ab.

  • But the chariot trial is for progressive MS in particular wheelchair-bound patients whose edss is over 6.5 and whose chance with covid is apparently according to yourselves not great so how can the trial be currently safe?

  • Ahhh MD – this is good news! Although I’m aware it is only 2 pwMS & the unknown grim reaper itself COVID-19 latching onto no other known comorbidities hosts. But we will take this as a ‘win!’ Thank you!

    The huge selling point, oops efficacy rate, could be that we are given a ‘cloak of invincibility’ along with our treatment – with a warning on the side of the tin, this might not work for everyone!

    The most important part of anyone I believe with MS is to ensure that you get supported early on & I agree, to start treatment early on and or at least be given the choice, should be part of the consultation.

    Believe me, just to have an appmt early on when you’re going through extremely stressful times with all the symptoms & feeling very unwell, in itself, not a great process. The Gp LACK initial understanding, didn’t want to send for expensive tests, felt it was just a virus & stress & although seemed to be show a great deal of empathy, when I was given a referral – it then took a further 6 months & a resourceful person to get seem by a Neuro! I had to call & speak to a secretary of the department, who found my referral on a desk waiting to be actioned! Imagine, being really unwell, you know it is not just a virus/stress breakdown, then to be under further stress (dealing with it all on your own) only to be lost in the long list of outstanding patients – my treatment should have possibly started then – but I then had to endure lots of tests (you know that lovely lumbar puncture) & a whole year under the CIS radar! A whole year later I then was diagnosed with MS!

    So, treatment should be available at the outset (options would be great) – but the process in seeing someone in relation to an Neurological problem, is a problem in itself. How do we go forward in the 2021, given more time to reflect on how we do things, can we make this a better process for patients and their families. The families around these people, are also living with the frustrations of the overcrowded world of being seen by a specialist too!

    Sorry, I went off on a bit a rant – I guess, it has left its mark pardon the pun!

    I would love to organise everyone – (I love organising sorry, it’s in me!) – I know it’s a tough world out there, possibly too many pw Neuro probs and I get that, but can’t we at least start the process off better & share the load more, throughout the Country (Countries) – it might be manageable more, if the people making the decisions, were in the real world and had a taste of what it is like.

    Too early for Happy …………….. but have a good week everyone 🙂 xxx

  • I too am seeing the neuro Friday and have about 10 questions prepared. In particular about brain volume loss, vaccines, of course and treatments. I doubt if I need a treatment as I can walk, run, swim long distance and have had MS for donkeys’ years anyway, without much wrong, outwardly anyway. I’m medication-averse anyway and have just spent 17 weeks taking myself off everything, anti depressants and mood stabilisers with no ill effects. But I do keep taking the vD. I don’t recommend people taking themselves off meds on their own, but this is a funny year and I’m both patient and arrogant. A great combination.

    • I suspect vaccines are abit too early to talk about, but I guess you can plan for vaccines and disease reactivation…hope it doesnt happen

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