Magnetic Resonance Imaging Evidence Supporting the Efficacy of Cladribine Tablets in the Treatment of Relapsing-Remitting Multiple Sclerosis.

IF 7.4 2区 医学 Q1 CLINICAL NEUROLOGY CNS drugs Pub Date : 2024-04-01 Epub Date: 2024-03-15 DOI:10.1007/s40263-024-01074-3
Rosa Cortese, Giovanna Testa, Francesco Assogna, Nicola De Stefano
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Abstract

Numerous therapies are currently available to modify the disease course of multiple sclerosis (MS). Magnetic resonance imaging (MRI) plays a pivotal role in assessing treatment response by providing insights into disease activity and clinical progression. Integrating MRI findings with clinical and laboratory data enables a comprehensive assessment of the disease course. Among available MS treatments, cladribine is emerging as a promising option due to its role as a selective immune reconstitution therapy, with a notable impact on B cells and a lesser effect on T cells. This work emphasizes the assessment of MRI's contribution to MS treatment, particularly focusing on the influence of cladribine tablets on imaging outcomes, encompassing data from pivotal and real-world studies. The evidence highlights that cladribine, compared with placebo, not only exhibits a reduction in inflammatory imaging markers, such as T1-Gd+, T2 and combined unique active (CUA) lesions, but also mitigates the effect on brain volume loss, particularly within grey matter. Importantly, cladribine reveals early action by reducing CUA lesions within the first months of treatment, regardless of a patient's initial conditions. The selective mechanism of action, and sustained efficacy beyond year 2, combined with its early onset of action, collectively position cladribine tablets as a pivotal component in the therapeutic paradigm for MS. Overall, MRI, along with clinical measures, has played a substantial role in showcasing the effectiveness of cladribine in addressing both the inflammatory and neurodegenerative aspects of MS.

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支持克拉利宾片治疗复发性多发性硬化症疗效的磁共振成像证据
目前有多种疗法可用于改变多发性硬化症(MS)的病程。核磁共振成像(MRI)通过深入了解疾病活动和临床进展情况,在评估治疗反应方面发挥着关键作用。将磁共振成像结果与临床和实验室数据相结合,可对疾病进程进行全面评估。在现有的多发性硬化症治疗方法中,克拉利宾作为一种选择性免疫重建疗法,对B细胞的影响显著,而对T细胞的影响较小,因此正在成为一种很有前景的选择。这项工作强调评估核磁共振成像对多发性硬化症治疗的贡献,尤其关注克拉利宾片对成像结果的影响,包括关键研究和实际研究的数据。这些证据强调,与安慰剂相比,克拉利宾不仅能减少炎症成像标志物,如 T1-Gd+、T2 和联合独特活性(CUA)病变,还能减轻对脑容量损失的影响,尤其是在灰质中。重要的是,无论患者的初始病情如何,克拉利宾都能在治疗的头几个月内减少CUA病变,从而显示出早期作用。克雷利宾片的选择性作用机制、第二年后的持续疗效以及它的早期起效,共同将克雷利宾片定位为多发性硬化症治疗范例中的关键组成部分。总体而言,核磁共振成像和临床测量在展示克拉利宾治疗多发性硬化症的炎症和神经退行性方面的有效性方面发挥了重要作用。
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来源期刊
CNS drugs
CNS drugs 医学-精神病学
CiteScore
12.00
自引率
3.30%
发文量
82
审稿时长
6-12 weeks
期刊介绍: CNS Drugs promotes rational pharmacotherapy within the disciplines of clinical psychiatry and neurology. The Journal includes: - Overviews of contentious or emerging issues. - Comprehensive narrative reviews that provide an authoritative source of information on pharmacological approaches to managing neurological and psychiatric illnesses. - Systematic reviews that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement. - Adis Drug Reviews of the properties and place in therapy of both newer and established drugs in neurology and psychiatry. - Original research articles reporting the results of well-designed studies with a strong link to clinical practice, such as clinical pharmacodynamic and pharmacokinetic studies, clinical trials, meta-analyses, outcomes research, and pharmacoeconomic and pharmacoepidemiological studies. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in CNS Drugs may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.
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