Abstract
Cladribine is an effective disease-modifying treatment for relapsing-remitting multiple sclerosis that acts as an immune reconstitution therapy and is administered in a pulsed manner. Despite its efficacy, severe disease reactivation early after treatment represents a serious clinical problem, and clear evidence to guide the management of such a situation is lacking. Here, we describe the case of a patient experiencing considerable disease activity during the 1st year after the initiation of cladribine treatment. The patient was switched to alemtuzumab and, therefore, received double immune reconstitution therapy. Data regarding this approach are lacking, and real-world observations may be of interest. Despite achieving good control of disease activity, we observed several serious infectious complications. Our results suggest that sequential immune reconstitution therapies may be effective; however, at the price of higher susceptibility to infections.
Highlights
Cladribine and alemtuzumab have proven to be effective treatments for relapsing-remitting multiple sclerosis (RRMS), and both act as immune reconstitution therapies administered in a pulsed manner [1,2,3]
We report a case of considerable ongoing disease activity after the first course of cladribine treatment, which was managed with alemtuzumab administration
We report the case of a 42-year-old patient diagnosed with RRMS at the age of 24 years, which was treated with different disease-modifying therapies
Summary
Cladribine and alemtuzumab have proven to be effective treatments for relapsing-remitting multiple sclerosis (RRMS), and both act as immune reconstitution therapies administered in a pulsed manner [1,2,3]. Disease activity may occur early after the first course of treatment This does not necessarily imply a treatment failure that requires further modifications to the treatment strategy. We report a case of considerable ongoing disease activity after the first course of cladribine treatment, which was managed with alemtuzumab administration. Data regarding this sequence of therapies, which act through immune system depletion and reconstitution, are lacking, and real-world observations are, of interest. The patient achieved disease stability; several infectious complications were observed This suggests that this sequential treatment strategy can be applied but warrants caution and careful monitoring. Written informed consent was obtained from the patient for the use of clinical data and imaging studies
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