Cladribine (2-chlorodeoxyadenosine)

 
 Cladribine is an immunosuppressive agent that leads to the destruction of relatively selective cells (apoptosis) and because of its toxicity and cellular resistance to adenosine deaminase. Has been studied in patients who suffer from MS, and is used in the treatment of lymphoid malignancies and other autoimmune diseases.

Results after the first year of a double-blind crossover study, and placebo in 50 patients with MS-out, which was scheduled to last two years are favorable. Patients remained (measured in degrees and the total volume of neural lesion on MRI) stable or improved in patients treated with cladribine, but it became worse in patients who received placebo. These positive results have not, however, in recent randomized Phase III study in 159 patients out with MS receiving cladribine administered two different doses (and reiterates 0.7 or 2.1 mg / kg) or placebo. Topics that were monthly assessments for 12 months, and the serial number undergo evaluation of disability scores and classroom MRI. Although treatment with cladribine have a major impact in reducing lesions on MRI, there was no significant impact on the deficit. Side effects of this drug are myelosuppression and susceptibility to viral infection (including herpes zoster).

Methotrexate

Methotrexate is immune. The oral administration of a relatively low dose, effective and non-toxic in other autoimmune diseases such as rheumatoid arthritis and psoriasis. The first test showed in the treatment of MS some decline in the frequency of relapses, but no benefit in patients suffering from Multiple Sclerosis gradual.

In a recent study, 60 ambulatory patients with progressive MS, and moderate or severe disability in the methotrexate 7.5 mg per week or placebo for two years. In the group that received treatment, significantly reduced the damage in the composite endpoint (EDSS arm evaluation function), it was noted the maximum benefit of the study early.

However, this is not important treatment effect when analyzed according to the traditional endpoint and EDSS. The impact of the disease on MRI activity also marginal. This was well tolerated low-dose methotrexate and no patient treatment stalled because of adverse events. Can it be treated for long periods with methotrexate cause irritation of the mucous membranes, and gastrointestinal symptoms, liver, and pulmonary fibrosis, and myelosuppression.

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