Subject: Re: Cladribine

From: Jackie Ferguson <[email-masked]>
Date: Sat, 12 Oct 1996 23:49:03 -0400

Simon James Wiehe wrote:
> 
> Hi,
> 
> My father-in-law has progresive MS, and has just seen a new specialist,
> one who specialised purely in MS.  My father in law has been asked to go
> on a trial for Cladribine.
> 
> Has anyone seen or heard of this drug ? Does anyone know of this drug
> under another name ? Does anyone know of any side effects ? Does anyone
> know of  its performance ?Is anyone else involved in the trial ?
> 
> Your help will be appreciated.
> 
> Simon
> 
> --
> Simon James Wiehe
****

Simon,

RE: Cladribine trade name is 2CdA (2-chlorodeoxyadenosine. It is FDA
approved for hairy cell leukemia and certain lymphomas.  In fact,
according to the oncologist who administered the drug to me, it CURES
hairy cell leukemia!! It's a potent imunosuppressant.  It specifically
targets T lymphocytes, especially t-4 cells (and to a lesser extent t-8
cells).  Since t-4 cells are considered one of the worst bad guys in MS,
one can understand the rationale for trying it for MS.  In the original
study, done by the Scripps Institute in La Jo, CA.(and as reported in
Lancet), there were about 30 patients who received the drug, with an
equal number of controls (sorry, I don't remember the exact number). 
The patients who got the drug mostly stabilized or improved, while more
of the controls deteriorated, with a few stabilizing.  It was a small
study, not well controlled, so a large multicentered study is underway.

In the original study, all the patients got cladribine intravenously,
one week/month for 4 months, I think.  In the current trial, the
patients are getting a more concentrated formulation and are getting it
by the simpler, self-injectable subcutaneous route ... one week/month
for 4 months.  It's a 3 3 pronged study.  Patients: 1/3 are controls --
get a placebo. 1/3 get low 
dose clad.  1/3 get high dose clad.  Again one week/month for 4 months. 
This
is a powerful drug.  It suppresses the white blood cells, especially the
neutrophils and t-cells.  The patient has to be monitered very carefully
with frequent blood counts.  If it gets too low ... the treatment may
have to be delayed ... and in some cases a "rescue" drug may have to be
given to raise the blood count.  To my knowledge, there have been no
fatalities "yet" among MS patients who got this drug.  In my case, I did
get "profound neutropenia"on a few occasions.  I had to take
prophyllactic antibiotics, avoid other people and take other precautions
to avoid infections.  I was a sitting duck for a simple infection which
could have raised havoc with my crippled immune system.  Fortunately I'm
fine now.

The patient doesn't *feel* any side effects, as with other chemo drugs
... there is no nausea, vomiting, or hair loss.  No malaise.  Nothing! 
After the first treatment I had a mild headache -- which easily could
have been due to stress!  It was relieved by Tylenol.  Never had any
problems again.  After my treatments (which took 1-2 hours) I went about
my day.  I and my neurologist both thought I stabilized.  That was over
a year ago.  I'm still quite stabile.  I've gotten to be a maven on
exercise.  And I owe my improvement 
to my exercises.

My cladribine was ordered by a private neurologist in NYC ... I
definitely got the drug ... was not part of a controlled study.

I can get you more specific information .... the name of the
pharmaceutical company, who to call for more information, etc.  Just
don't have it handy (it's in another part of the computer!)

I'm happy I took the drug ... best wishes to you if you should decide to
take it (best wishes no matter what).

You can email me directly if you wish.
			2
Jackie Ferguson, RN, MS  
[email-masked]