Emerging oral treatments in multiple sclerosis – clinical utility of cladribine tablets

Claudio Gasperini1, Serena Ruggieri2, Carlo Pozzilli21Department of Neurosciences, S Camillo Forlanini Hospital, Rome, Italy; 2Department of Neurological Sciences, University of Rome “La Sapienza”, ItalyAbstract: Multiple sclerosis (MS) is a chronic inflammatory disorder of the central ­nervous system (CNS) that represents one of the first causes of neurological disability in young adults. Although the pathogenesis of MS is still unclear, an autoimmune mechanism has been ­demonstrated. According to this evidence in the last 15 years different treatments acting on the immune system have been developed. Current disease-modifying drugs (DMDs) for MS require regular and frequent parenteral administration and are associated with limited ­long-term treatment adherence. Moreover the clinical efficacy of these disease-modifying drugs is ­suboptimal. Thus, there is an important need for the development of new therapeutic strategies. Several oral ­therapies (fingolimod, fumaric acid, teriflunomide, laquinimod) are in development; Among these cladribine is the only therapy with the potential for short-course dosing. Cladribine is an immunosuppressant that offers sustained regulation of the immune system through a preferential lymphocyte depleting action. Cladribine has a well-characterized and well-known safety profile, derived from more than 15 years of use of the parenteral formulation both in the oncology field and in MS. This paper reviews the new oral emerging treatments and presents the available data about the use of cladribine in MS and the future perspective of its clinical use.Keywords: multiple sclerosis, disease modifying drugs, oral therapy, treatment adherence, cladribine