Thomas Leist, MD

“Even after replenishing lymphocytes, the biologic effect of cladribine resides in the patient even though  the lymphocyte counts have normalized.”

Cladribine, an agent for multiple sclerosis (MS) treatment that acts specifically on lymphocytes, has shown success in trials as a short-term therapy that results in long-term disease remission. It reduces B and T cells in order to, in a way, reset the immune system.

Although, due to the treatment course, the question of whether or not there is a potential utility for this treatment to grant protection against MS arises. For Thomas Leist, MD, this is an interesting point of contention.

At the 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) in Berlin, Germany, Leist spoke with 

 about cladribine and its mechanism of action, as well as its possible use if approved. The professor of neurology and director of the Comprehensive Multiple Sclerosis Center at Thomas Jefferson University discussed cladribine in totality, as well as how its effects have been demonstrated in clinical trials.

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The director of the Comprehensive Multiple Sclerosis Center at Thomas Jefferson University discussed the concept of lymphocyte depletion to reset the immune system.

Thomas Leist, MD: Resetting the Immune System With Cladribine

“The whole concept behind these treatments is that we try to reset the immune system in multiple sclerosis in a direction of a non-self-aggressive, non-self-reactive immune system.”

Recently, there has been a move toward the development of immune reconstitution therapies for multiple sclerosis (MS). These therapies, administered in short treatment courses, reduce immune cells in order to essentially reset the immune system to a non-self-reactive state. Two notable examples are alemtuzumab and cladribine. 

Although not approved in the United States, Thomas Leist, MD, has worked closely with cladribine in its clinical development through the ORACLE and CLARITY trials. In ORACLE,  patients with clinically isolated syndrome (CIS), the first event toward a diagnosis of MS, were given the oral therapy with very positive results in reducing the risk of patients advancing to clinically definite MS. Despite an observed slightly increased oncologic risk, this was not observed in subsequential trials.

At the 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) in Berlin, Germany, the professor of neurology and director of the Comprehensive Multiple Sclerosis Center at Thomas Jefferson University sat with 

 to share his experience with cladribine and with this class of medications.

The director of Thomas Jefferson's Comprehensive Multiple Sclerosis Center spoke about the introduction of this treatment method into MS.

Author | Thomas Leist, MD

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Thomas Leist, MD: Resetting the Immune System With Cladribine

Thomas Leist, MD: Immune Reconstitution Therapy for Multiple Sclerosis