Cladribine for Optioco spinal demyelinating disease

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So this study says that cladribine can inhibit NMO (spectrum disorder), you say this is MS what’s the big deal? and I say NoSS. Why?

Well NMO used to be a part of MS, but then it was seen to be different, with the suggestion that antibody was important to the disease course and importantly the treatments may be different. Therefore if your neuro got the diagnosis wrong your treatment could make the NMO worse. However as both MS and NMOSD respond to cladribine it would not matter if the diagnosis was wrong you would still respond. Now why the NSS. This is because this was shown in a patent years ago. But as you can see the person relapsed 3 years later…and should have got another dose not a switch. I suppose just goes to show why the conflicts of interest statments are a waste of time. NMO is said to antibody driven due to aquaporin 4 and myelin oliogdendrocyte glycoprotein antibodies, but it also responds to anti CD20 which does not touch plasma cells.

figure from patent

Rejdak K, Papuć E. Cladribine suppresses disease activity in neuromyelitis optica spectrum disorder: a two year follow up study. Eur J Neurol. 2021 Jul 7. doi: 10.1111/ene.15012. Epub ahead of print. 

Background: Neuromyelitis optica spectrum disorder (NMOSD) is a difficult to treat condition. Cladribine selectively and transiently depletes B and T lymphocytes, leading to long-lasting immune reconstitution. This report describes observations from 24 months of follow-up after cladribine in NMOSD patients.

Methods: Retrospective analysis of a case series, including 12 seropositive patients with NMOSD. Patients were given cladribine by subcutaneous injections in a series of several two-day cycles of 20 mg administered at intervals of 4-6 weeks. Thus, the full treatment course delivered a cumulative bioavailable dose similar to that approved for treatment of multiple sclerosis. Annualized relapse rate (ARR), disability (Expanded Disability Status Scale score), and safety in the 24 months preceding and the 24 months following the initiation of cladribine treatment were assessed.

Results: The mean ARR in the 24 month preceding cladribine treatment was 1.04 (95% CI, 0.67 – 1.62). The mean ARR in the 24 month following initiation of cladribine treatment was 0.21 (95% CI, 0.08 – 0.56). The ratio in the rate of events post vs. prior cladribine initiation was 0.20 (95% CI, 0.07 – 0.59) and highly significant (p=0.0073). The EDSS score did not change over the follow-up period (2.5±1.7; mean±SD) compared to baseline (2.5±1.5; mean±SD). No serious adverse events considered linked to cladribine were observed during follow-up.

Conclusions: Cladribine was safe in NMOSD patients over a 2-year observation period. Cladribine treatment was associated with clinical stabilization, as evidenced by significantly decreased annualized relapse rate, and no progression of EDSS scores.COI

COI: Multiple

Disclaimer: Please note that the opinions expressed here are those of the author and do not reflect the positions of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust or Queen Mary Univeristy of London.

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