Mavenclad may pull double duty for MS and other autoimmune conditions
Registry study suggests the oral therapy might reduce the need for extra drugs
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Mavenclad may help manage coexisting autoimmune diseases alongside MS, potentially reducing the need for extra medications. (Photo from iStock)
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Mavenclad (cladribine) for MS may also manage certain coexisting autoimmune diseases.
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This treatment could reduce the need for multiple immunosuppressive therapies in some patients.
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However, some autoimmune conditions still require separate treatments; more research is needed.
In addition to controlling multiple sclerosis (MS), the approved therapy Mavenclad (cladribine) may also help manage certain coexisting autoimmune diseases, potentially allowing some patients to avoid taking multiple immunosuppressive therapies simultaneously.
The findings come from a review of eight adults in the French MS Registry (NCT02889965) who had both MS and other autoimmune disorders. While Mavenclad successfully kept both MS and conditions like sarcoidosis or ankylosing spondylitis stable in some individuals, other patients in the group still required separate treatments for their secondary illness.
“Overall, the findings suggest that cladribine could be a useful treatment option for certain patients with both MS and autoimmune comorbidities, potentially reducing the need for multiple therapies,” researchers wrote.
The study, “Cladribine use for multiple sclerosis with autoimmune comorbidities: retrospective analysis of the French MS registry, case series, and therapeutic considerations,” was published in Therapeutic Advances in Neurological Disorders.
The challenge of managing multiple autoimmune diseases
MS is a neurological condition with autoimmune origins. It occurs when the immune system mistakenly attacks myelin, a protective coating around nerve cells, leading to inflammation and damage.
People with MS are more likely than the general population to have another autoimmune disease, likely because some of these conditions share genetic risk factors and immune mechanisms. Treating these patients can be challenging because therapies for one disease may worsen another, or patients may need to take two immunosuppressive medications at the same time, increasing the risk of side effects.
“The optimal scenario is when both MS and the concurrent autoimmune disease can be treated with the same medication,” the researchers wrote.
The team hypothesized that Mavenclad could offer that possibility for some patients. The oral therapy, approved for relapsing forms of MS, is taken no more than 10 days a year for two years.
The treatment temporarily reduces immune T- and B-cells before allowing the immune system to rebuild. Scientists believe this essentially resets the immune system, potentially helping control MS and other autoimmune diseases.
To probe this, the researchers analyzed data from the French MS Registry, which included 11,410 people with MS treated across five centers. Of the 385 patients who received Mavenclad, 10.1% also had another autoimmune disease.
To explore whether Mavenclad could address both MS and these coexisting conditions, the team examined eight illustrative cases.
Three patients had ankylosing spondylitis, an inflammatory disease that mainly affects the spine. Between 1.5 and three years after starting Mavenclad, none had experienced new MS or ankylosing spondylitis activity, although two continued to have pain from existing joint damage.
According to the researchers, these cases suggest that Mavenclad may help control both diseases while delaying the need for additional ankylosing spondylitis-specific immunosuppressive therapy.
Another patient had both MS and sarcoidosis, in which clumps of inflammatory cells form in tissues and organs throughout the body. Doctors initially misidentified her MS lesions as signs of sarcoidosis in the nervous system. However, after reaching the correct diagnosis, she began Mavenclad and remained free of new disease activity from either condition six months later.
When separate therapies are still necessary
Other patients still required additional treatment for their autoimmune disease. A woman with rheumatoid arthritis, in which autoimmune attacks on joint tissues lead to pain and swelling, and another with psoriasis, a skin disease that causes scaly patches, continued receiving separate immunosuppressive therapies. However, the short-term dosing of Mavenclad meant they didn’t require two continuous, daily immunosuppressants.
Mavenclad also appeared to have little effect on psoriatic arthritis, a form of psoriasis that affects the joints. Two patients experienced stable MS after treatment, but they continued to have flare-ups of their joint disease.
Although the cases highlight situations in which Mavenclad may help manage both MS and another autoimmune disease, the researchers stressed that the findings are exploratory. A case series involving eight patients cannot establish a treatment’s safety or effectiveness; larger studies are needed to determine which autoimmune disorders are more likely to respond to Mavenclad.
The findings also underscore that many patients will still require separate treatment for their coexisting disease.
“A multidisciplinary, personalized approach to treatment decision remains essential when [autoimmune] disorders coexist,” the researchers wrote.
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