Understanding the Clinical Advantages of Cladribine and its Impacts on Oligoclonal Bands: Nicola De Stefano, MD, PhD

WATCH TIME: 4 minutes

"This means to some extent that, the synthesis of immunoglobulins is actually decreasing to some extent, due to the immune reconstitution happening when you're taking the medication."

Cladribine is an analog of deoxyadenosine that contains a substation of a chlorine atom for a hydrogen atom at position two of the purine ring, rendering it resistant to deamination by adenosine deaminase. The therapy, which has been approved for several years, mimics severe immunodeficiency disorder by selectively disrupting T-cell and B-cell immunity. Within cells, high cladribine concentrations increase the expression of deoxycytidine kinase, leading to lymphocyte apoptosis.

At the 2024 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, held May 29-June 2, in Nashville, Tennessee, post-hoc data from the phase 4 MAGNIFY-MS trial (NCT03364036) continued to highlight cladribine’s impact on central nervous system in patients with highly active multiple sclerosis (MS). Led by Nicola De Stefano, MD, PhD, the treatment resulted in increased rates of no evidence of disease activity (NEDA) or progression (NEPAD), with additional impacts on markers of disease progression, axonal loss, and oligoclonal bands.

In year 1 (Y1), NEDA-3 rate was 32.8% (95% CI, 26.9%-39.4%; n = 229) and NEPAD rate was 32.1% (95% CI, 26.3%-38.6%; n = 229). During year 2 (Y2), NEDA-3 rate was 64.1% (95% CI, 57.2%-70.4%; n = 207) and NEPAD rate was 60.2% (95% CI, 53.3%-66.7%; n = 207). Complete oligoclonal band disappearance was observed for 2 patients (12.5%) from baseline to M12 and 1 patient (8.3%) from baseline to M24. In addition, a decrease in oligoclonal band counts were reported for 9 patients (75.0%) from baseline to M24.

De Stefano, a professor of neurology in the department of medicine, surgery, and neuroscience at the University of Siena, sat down with NeurologyLive^® at the meeting to discuss the findings in detail. In this clip, he spoke on the therapeutic benefits of cladribine and how it differs from other previously approved disease-modifying therapies. Additionally, he provided in-depth context on the significance of cladribine’s impact on oligoclonal bands and what this means for patients and clinicians alike.

Click here for more coverage of CMSC 2024.

REFERENCE
1. De Stefano N, Achiron A, Barkhof F, et al. Effect of cladribine tablets on markers of disease progression, axonal loss, and oligoclonal bands in patients with relapsing multiple sclerosis: results from MAGNIFY-MS. Presented at: 2024 CMSC Annual Meeting; May 29-June 2; Nashville, TN. ABSTRACT DMT01