I: Adult patients with highly active relapsing-remitting multiple sclerosis (MS), as defined by clinical or imaging findings. PO: Dose of 3.5 mg/kg body weight over 2 years, administered as 1 treatment phase of 1.75 mg/kg per year. CI: Hypersensitivity to cladribine or any of the excipients. Infection with the human immunodeficiency virus (HIV). Severe active infections, active chronic infection (e.g. tuberculosis or hepatitis). Initiation of treatment in immunocompromised patients. Existing active malignant disease. History of progressive multifocal leukoencephalopathy. Moderate or severe impairment of renal function. Children and adolescents under 18 years. Pregnancy and breast-feeding. W: General: Not recommended in patients with inactive disease or stabilised on established therapy. No more than 2 annual treatment phases within 4 years. Haematological monitoring: The lymphocyte count must be determined before the start of treatment with Mavenclad in year 1 and year 2, as well as 2 and 6 months after initiation of treatment in each year of treatment. Infections: Cladribine can weaken the body's immune system and potentially increase the likelihood of infection. Patients with lymphocyte counts below 500 cells/mm(3) must be actively monitored for signs and symptoms of infection, especially herpes zoster. Malignant disease: Cladribine interferes with DNA synthesis and has an immunosuppressive effect. Contraception: Reliable contraceptive methods must be used during treatment with cladribine and for at least 6 months after the last dose. Blood transfusions: In patients requiring blood transfusions, irradiation of the cellular blood components is recommended prior to transfusion. Switching to cladribine and from cladribine to other medicinal products: Before starting treatment with Mavenclad, the mechanism of action and duration of action of the other medicinal product should be taken into account. Renal disease: Mavenclad must not be used in cases of moderate or severe impairment of renal function. Hepatic disease: Mavenclad is not recommended in cases of moderate or severe impairment of liver function. Fructose intolerance: Patients with fructose intolerance should not take Mavenclad. IA: Mavenclad contains hydroxypropylbetadex, which may be able to form complexes with other medicinal products and hence lead to increased bioavailability of these medicinal products. Haematotoxic or immunosuppressive medicines (methotrexate, cyclophosphamide, ciclosporin, azathioprine, corticosteroids). Other disease-modifying drugs. Haematotoxic medicines (carbamazepine). Live vaccines and live attenuated vaccines. Potent inhibitors of ENT1, CNT3 and BCRP transporters (such as dilazep, nifedipine, nimodipine, cilostazol, sulindac, reserpine). Potent inducers of BCRP and P-gp transporters (e.g. corticosteroids and rifampicin, St. John's wort). Hormonal contraceptives. Most common UE: lymphopenia, oral herpes, dermatomal herpes zoster, reduction in neutrophil count, rash, alopecia. P: Mavenclad 10 mg: 1, 4 or 6 tablets. [A] For detailed information, see www.swissmedicinfo.ch [http://www.swissmedicinfo.ch/]. FEB19
About Multiple Sclerosis
Multiple sclerosis (MS) is a chronic, inflammatory condition of the central nervous system and is the most common, non-traumatic, disabling neurological disease in young adults. It is estimated that approximately 2.3 million people have MS worldwide. While symptoms can vary, the most common symptoms of MS include blurred vision, numbness or tingling in the limbs and problems with strength and coordination. The relapsing forms of MS are the most common.
Merck in Multiple Sclerosis
Merck has a long-standing legacy in neurology and immunology, with significant R&D and commercial experience in multiple sclerosis (MS). Merck's current portfolio includes two products for the treatment of relapsing MS, with a robust pipeline focusing on discovering new therapies that have the potential to modulate key pathogenic mechanisms in MS. Merck aims to improve the lives of those living with MS, by addressing areas of unmet medical needs.
About Merck
Merck, a leading science and technology company, operates across healthcare, life science and performance materials. Around 52,000 employees work to make a positive difference to millions of people's lives every day by creating more joyful and sustainable ways to live. From advancing gene editing technologies and discovering unique ways to treat the most challenging diseases to enabling the intelligence of devices - the company is everywhere. In 2018, Merck generated sales of EUR 14.8 billion in 66 countries.
Scientific exploration and responsible entrepreneurship have been key to Merck's technological and scientific advances. This is how Merck has thrived since its founding in 1668. The founding family remains the majority owner of the publicly listed company. Merck holds the global rights to the Merck name and brand. The only exceptions are the United States and Canada, where the business sectors of Merck operate as EMD Serono in healthcare, MilliporeSigma in life science, and EMD Performance Materials.
* Defined as: patients with one relapse during the previous year and >= 1 T1 Gd+ lesion or >= 9 T2 lesions while on therapy with other disease modifying drugs (DMD); OR patients with >= 2 or more relapses in the previous year, whether on DMD treatment or not.
References:
[1] MAVENCLAD() Summary of Product Characteristics February 2019
[2] Giovannoni G, Comi G, Cook S et al. A Placebo-Controlled Trial of Oral Cladribine for Relapsing Multiple Sclerosis. 2010 New England Journal of Medicine 362:416-426
[3] Giovannoni G et al. Sustained disease-activity-free status in patients with relapsing-remitting multiple sclerosis treated with cladribine tablets in the CLARITY study: a post-hoc and subgroup analysis. Lancet Neurol 2011; 10:329-337
[4] EU Clinical Trials Register. A Phase IIIb, Double-Blind, Placebo-Controlled, Multicenter, Parallel Group, Extension Trial to Evaluate the Safety and Tolerability of Oral Cladribine in Subjects with Relapsing-Remitting Multiple Sclerosis Who Have Completed Trial 25643 (CLARITY). Available at https://www.clinicaltrialsregister.eu/ctr-search/trial/2007-... [https://www.clinicaltrialsregister.eu/ctr-search/trial/2007-...]. Last accessed March 2019
[5] Leist T, Comi G, Cree B et al. Effect of oral cladribine on time to conversion to clinically definite multiple sclerosis in patients with a first demyelinating event (ORACLE MS): a phase 3 randomised trial. Lancet Neurol 2014; 13: 257-67
[6] EU Clinical Trials Register. A phase II, multicenter, randomized, double-blind, placebo-controlled, safety, tolerability and efficacy study of add-on Cladribine tablet therapy with Rebif New Formulation in Multiple Sclerosis Subjects with Active Disease. Available at https://www.clinicaltrialsregister.eu/ctr-search/trial/2006-... [https://www.clinicaltrialsregister.eu/ctr-search/trial/2006-...]. Last accessed March 2019
[7] Schreiner T, Miravalle A. Current and Emerging Therapies for the Treatment of Multiple Sclerosis: Focus on Cladribine. Journal of Central Nervous System Disease. 2012; 4: 1-14
[8] Giovannoni G, Sorensen P, Cook S et al. Efficacy of Cladribine Tablets in high disease activity subgroups of patients with relapsing multiple sclerosis: A post hoc analysis of the CLARITY study. 2018 Multiple Sclerosis Journal 1-9 [Epub ahead of print]
[9] Giovannoni G, Sorensen P, Cook S et al. Safety and efficacy of cladribine tablets in patients with relapsing-remitting multiple sclerosis: Results from the randomized extension trial of the CLARITY study. 2018 Multiple Sclerosis Journal 24(12) 1594-1604
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