Cladribine in the treatment of relapsing multiple sclerosis
*Correspondencia: Dr. René Robles Cedeño. Unitat de Neuroimmunologia i Esclerosi Múltiple Territorial Girona (UNIEMTG). Gerència Territorial Girona. Institut Català de la Salut. Hospital Santa Caterina. Edifici La República. Doctor Castany, s/n. E-17190 Salt (Girona).
E-mail: rrobles.girona.ics@gencat.cat
Multiple sclerosis is a chronic neurological disease of the central nervous system where inflammation and neurodegeneration converge, inducing a disorder with both a progressive course and a high degree of disability. Multiple sclerosis usually begins between the ages of 20 and 40 and affects two to three times as many women as men. The main objective of pharmacological management is to reduce the inflammation and to delay the disability onset. Many of the currently available drugs have shown different degrees of efficacy associated to a specific adverse events profile. In routine clinical practice, an usual therapeutic approach is called escalation therapy; that is, starting with a moderate-efficacy treatment according to the clinical-radiological inflammatory profile, taking into account the patient's personal situation (pregnancy desire, fear of needles, prior comorbidity) and then move on to a high-efficacy treatment in case of suboptimal response. Thus, adverse events are minimized. However, many authors defend a more aggressive approach (induction therapy); that is, using high-efficacy treatments in the early stages to, after controlling the inflammation, move on to a moderate-efficacy treatment. Cladribine is an oral immunosuppressant recently approved in Europe for the treatment of highly active relapsing multiple sclerosis. Its effectiveness, comfort in posology and safety, make it an option not only for aggressive forms of the disease, but as a possible induction therapy.
