Chariot MS Study of Off-Label Cladribine in Advanced MS: Kimberly Allen-Philbey


The PhD candidate at the Barts MS Center in London discussed the upcoming Chariot MS study as well as further research she would like to conduct in personalized cladribine dosing.

“This work has been the foundation for the Chariot MS trial. Chariot MS will look at the use of cladribine tablets in a controlled setting. So, work thus far is uncontrolled, [in] an uncontrolled cohort of patients. But Chariot MS will be a multicenter, placebo-controlled trial of cladribine tablets and patients with advanced MS.”

Subcutaneous cladribine personalized dosing (CPD) is well-tolerated in patients with relapsing multiple sclerosis (RMS), with efficacy in line with oral cladribine (Mavenclad; EMD Serono) trial data, according to data from a recent study. These findings were presented at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2021, February 25-27, by first author Kimberley Allen-Philbey, PhD candidate, Barts MS Center, London.

Allen-Philbey and colleagues utilized a treatment schedule that consisted of 10 mg on 3 consecutive days in week 1 (4 days in people over 90 kg), followed by another 0-3 doses in week 5 based on total lymphocyte count in week 4. A second cycle of CPD was administered 11 months later. They found that over the follow-up period, 1 myocardial infarction, 1 breast cancer, 1 pulmonary embolism, and 3 severe allergic skin reactions without long-term sequelae occurred with CPD. Death occurred in 2 severely disabled patients with MS, 1 from influenza and 1 from encephalitis. Lymphopenia of at least grade 3 occurred in 7% of patients. 

EDSS remained stable or improved in 99 (82%) patients with MS with baseline and 2-year follow-up data. Of the 23 patients with MS that had elevated baseline cerebrospinal fluid neurofilament light (median, 652 pg/mL; interquartile range [IQR], 458-1063), 22 had normal levels at follow-up (median, 344 pg/mL; IQR, 186-505).

NeurologyLive spoke with Allen-Philbey to learn more about the Chariot MS study her team has planned. She also discussed further research she would like to conduct with off-label cladribine.

For more coverage of ACTRIMS Forum 2021, click here.

Allen-Philbey K, De Trane S, Stennett A, et al. Cladribine personalised dosing to treat active multiple sclerosis - follow-up in 250 patients. Presented at ACTRIMS Annual Forum; February 25-27, 2021. Abstract P160.
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