#ResearchSpeak & #ThinkSpeak: a new form of therapeutic nihilism

Gavin-Giovannoni-150x150Professor Gavin Giovannoni
Department of Neurology
Royal London Hospital

A commentator asked about data to support the use of cladribine in PPMS. In reality there has not been a study particularly targeting PPMS, but several studies have investigated the impact of cladribine in chronic progressive MS, i.e. a population that includes both secondary and primary progressive MS. In general these trials have been under-powered and too short, based on recent insights, to give a definitive answer. The best study was the Rice or J&J (Johnson & Johnson) study that included 48 (30%) patients with PPMS. Importantly, in this study 71% of patients had a baseline EDSS score of >=5.5, which based on our therapeutic lag modelling would require a study duration of well over 3 years to give an answer using a lower limb outcome (EDSS). However, despite this study being too small and too short cladribine had a robust impact on T2 lesions, albeit more pronounced in the SPMS subgroup. It is clear from this study that cladribine is an effective anti-inflammatory in more advanced MS.

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