Roles of Cladribine as a Treatment for Relapsing-remitting Multiple Sclerosis

Abstract

Multiple sclerosis results from B-lymphocyte and T-lymphocyte white blood cells destroying myelin sheath resulting in slowing conduction of nerve impulses that eventually causes malfunction of organs. The disease-modifying therapy for slowing progressing and extending longer periods of remission was used by mainly choosing the medications with the efficacy in reducing those white blood cells for a long period. Immune reconstitution therapy is presently an interesting concept on providing short-term medication but having the ability to reduce pathogenic white blood cells for a longer time. Cladribine is a medication in this group and currently being used in Thailand. This article reviews related literatures on cladribine. From the study on its efficacy and safety profile in phase 3 clinical trial and real-world study, the results are consistent, i.e., patients receiving cladribine tablets have a longer remission stage and less new lesions in the nerve system than those receiving placebo. Two adverse drug reactions to be cautious are neutropenia and increased chance of infection. Therefore, it is contraindicated in patients with immune deficiency and those with infection. The recommended dose is 3.5 milligrams per kilogram in two treatments one year apart – each receiving 1.75 milligrams per kilogram in 2 weeks. Prior to the second treatment, the number of white blood cells should be counted to prevent severe adverse drug reactions.