Cladribine (oral)
Class: Immunosuppressive Agents
Chemical Name: (2R,3S,5R)-5-(6-amino-2-chloropurin-9-yl)-2-(hydroxymethyl)oxolan-3-ol
Molecular Formula: C10H12ClN5O3
CAS Number: 123318-82-1
Brands: Mavenclad
Warning
- Malignancies
May increase risk of malignancy. (See Malignancies under Cautions.)
Contraindicated in patients with current malignancy; individualize use in patients with prior or increased risk of malignancy based on an assessment of risks versus benefits.
- Teratogenicity
Risk of fetal harm; contraindicated in pregnant women and in women and men of reproductive potential who do not plan to use effective contraception. (See Fetal/Neonatal Morbidity and Mortality under Cautions.)
Introduction
Purine nucleoside antimetabolite with immunomodulatory and disease-modifying activity in multiple sclerosis (MS).
Uses for Cladribine (oral)
Multiple Sclerosis (MS)
Used orally for treatment of relapsing forms of MS, including relapsing-remitting disease and active secondary progressive disease.
Because of substantial risks associated with the drug (e.g., malignancy, teratogenicity), generally reserved for patients with inadequate response to, or unable to tolerate, an alternative MS therapy. (See Boxed Warning and also see Cautions.)
Not indicated for use in patients with clinically isolated syndrome.
Cladribine is one of several disease-modifying therapies used in the management of relapsing forms of MS. Although not curative, these therapies have all been shown to modify several measures of disease activity, including relapse rates, new or enhancing magnetic resonance imaging (MRI) lesions, and disability progression.
The American Academy of Neurology (AAN) recommends that disease-modifying therapy be offered to patients with relapsing forms of MS who have had recent relapses and/or MRI activity. Clinicians should consider the adverse effects, tolerability, method of administration, safety, efficacy, and cost of the drugs in addition to patient preferences when selecting an appropriate therapy.
Cladribine (oral) Dosage and Administration
General
Screen for malignancies according to standard cancer screening guidelines prior to each cladribine treatment course. (See Malignancies under Cautions.)
Screen for HIV, tuberculosis, HBV, and HCV, and evaluate for active infections prior to each treatment course; in patients with active infections, consider delaying therapy until the infection is fully controlled.
Exclude pregnancy in women of childbearing potential prior to each treatment course. (See Fetal/Neonatal Morbidity and Mortality under Cautions.)
Complete any necessary immunizations prior to initiating therapy. Vaccination against varicella zoster virus (VZV) is recommended in antibody-negative patients. Administer live or live attenuated vaccines at least 4–6 weeks prior to initiation of t.
