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July 2017; 4 (4) ArticleOpen Access

Both cladribine and alemtuzumab may effect MS via B-cell depletion

David Baker, Samuel S. Herrod, Cesar Alvarez-Gonzalez, Lukasz Zalewski, Christo Albor, Klaus Schmierer
First published June 5, 2017, DOI: https://doi.org/10.1212/NXI.0000000000000360
David Baker
From the BartsMS (D.B., S.S.H., C.A.G., C.A., K.S.), Blizard Institute, ITS Research (L.Z.), Queen Mary University of London; and Barts Health NHS Trust (K.S.), Emergency Care & Acute Medicine Neuroscience Clinical Academic Group, London, UK.
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Samuel S. Herrod
From the BartsMS (D.B., S.S.H., C.A.G., C.A., K.S.), Blizard Institute, ITS Research (L.Z.), Queen Mary University of London; and Barts Health NHS Trust (K.S.), Emergency Care & Acute Medicine Neuroscience Clinical Academic Group, London, UK.
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Cesar Alvarez-Gonzalez
From the BartsMS (D.B., S.S.H., C.A.G., C.A., K.S.), Blizard Institute, ITS Research (L.Z.), Queen Mary University of London; and Barts Health NHS Trust (K.S.), Emergency Care & Acute Medicine Neuroscience Clinical Academic Group, London, UK.
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Lukasz Zalewski
From the BartsMS (D.B., S.S.H., C.A.G., C.A., K.S.), Blizard Institute, ITS Research (L.Z.), Queen Mary University of London; and Barts Health NHS Trust (K.S.), Emergency Care & Acute Medicine Neuroscience Clinical Academic Group, London, UK.
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Christo Albor
From the BartsMS (D.B., S.S.H., C.A.G., C.A., K.S.), Blizard Institute, ITS Research (L.Z.), Queen Mary University of London; and Barts Health NHS Trust (K.S.), Emergency Care & Acute Medicine Neuroscience Clinical Academic Group, London, UK.
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Klaus Schmierer
From the BartsMS (D.B., S.S.H., C.A.G., C.A., K.S.), Blizard Institute, ITS Research (L.Z.), Queen Mary University of London; and Barts Health NHS Trust (K.S.), Emergency Care & Acute Medicine Neuroscience Clinical Academic Group, London, UK.
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Citation
Both cladribine and alemtuzumab may effect MS via B-cell depletion
David Baker, Samuel S. Herrod, Cesar Alvarez-Gonzalez, Lukasz Zalewski, Christo Albor, Klaus Schmierer
Neurol Neuroimmunol Neuroinflamm Jul 2017, 4 (4) e360; DOI: 10.1212/NXI.0000000000000360

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This article has a correction. Please see:

  • Errata - September 01, 2017
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    Figure 1 Cladribine targets mainly lymphocytes

    Mean number of red blood cells and leucocytes following treatment with either placebo (n = 42–101. Typically, the lower limit of sample size was n = 63, except week on 55) or a total doses of either 3.5 mg/kg (n = 47–103. Typically, the lower limit of sample size was n = 67, except on week 55) or 5.25 mg/kg (n = 38–104. Typically, the lower limit of sample size was n = 62, except on week 55). Placebo (circle) or cladribine (CLAD) that was administered in monthly courses (inverse triangle) at 0, 5 and 48 and 52 weeks (diamond; 3.5 mg per dose) and additionally at 9 and 13 weeks (hexagon; 5.25 mg per dose). The results show the mean ± SEM of (A) red blood cells (B) platelets (C) white blood cells, (D) lymphocytes, (E) monocytes, (F) polymorphonuclear neutrophils, (G) eosinophils, or (H) basophils.

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    Figure 2 Cladribine preferentially depletes B lymphocytes compared with a modest depletion of T cells

    The results represent the mean percentage ± SEM of blood lymphocytes compared with baseline following treatment with either placebo (circle; n = 56–79) or total doses of either 3.5 mg/kg (diamond; n = 62–82) or 5.25/kg (hexagon; n = 66–81) cladribine (CLAD) administered in monthly courses (inverse triangle) at 0, 5 and 48 and 52 weeks (3.5 mg per dose) and additionally at 9 and 13 weeks (5.25 mg per dose). Results show the numbers of (A) CD3+ T cells, (B) CD19+ B cells, (C) CD4+ T cells (D) CD8+ T cells, and (E) CD4+-naive and (F) CD4+ memory T cells.

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    Figure 3 The incidence of relapse does not relate to peripheral blood CD3, CD4, CD8, CD19, T- and B-cell levels

    Cladribine (CLAD) was administered as weekly courses at 0, 5 and 48 and 52 weeks. The results represent the mean ± SEM absolute number (per cubic millimeter) of peripheral blood: (A) CD3, (B) CD19, (C) CD4, and (D) CD8 lymphocytes following treatment (inverse triangles) with oral CLAD in the CLAD Tablets Treating Multiple Sclerosis Orally (CLARITY) trial administered with 3.5 mg/kg CLAD and those divided into groups who remained healthy (circle; n = 121–136 per group) or those who had at least 1 relapse (diamond; n = 29–34). pwRMS = people with relapsing MS.

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    Figure 4 Depletion of lymphocyte subsets following alemtuzumab and cladribine treatment

    Cladribine (CLAD) was administered as weekly courses of CLAD at 0, 5 and 48 and 52 weeks (time of initiation of cycle; inverse triangle) or weekly courses of alemtuzumab (ALEM) at 0 and 52 weeks. The results represent the mean absolute number of peripheral blood lymphocytes (per cubic millimeter) during the CLAD Tablets Treating Multiple Sclerosis Orally (CLARITY) trial in people with relapsing MS (pwRMS) treated with either placebo (circle; n = 68–80), CLAD 3.5 mg/kg (diamond; n = 77–86), CLAD 5.25 mg/kg (hexagon; n = 79–84), and pwRMS in the Comparison of Alemtuzumab and Rebif Efficacy in Multiple Sclerosis, study one (CARE-MS I) trial treated with 12 mg/d ALEM (square; n = 171–184).

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