ReviewTherapeutic advances in neurological disorders2019
Pulsed immune reconstitution therapy in multiple sclerosis.
Review in Therapeutic advances in neurological disorders, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers.
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Who cites it
40 citing papers in PubMed.
- Signatures of immune reprogramming in anti-CD52 therapy of MS: markers for risk stratification and treatment response.Neurological research and practice · 2019Trial
- Immune reconstitution and tolerance-inducing therapies as promising therapeutic approaches in multiple sclerosis.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026Review
- Role of Immune Reconstitution Therapy with Cladribine Tablets in the Management of Relapsing Multiple Sclerosis in Older Patients.Neurology and therapy · 2025Review
- Real-world experience with cladribine tablets in people with multiple sclerosis: effectiveness data from a multicenter Italian study.Therapeutic advances in neurological disorders · 2025Article
- New autoimmune disorder development after immune reconstitution therapy for multiple sclerosis.Scientific reports · 2024Article
- Holistic, Long-Term Management of People with Relapsing Multiple Sclerosis with Cladribine Tablets: Expert Opinion from France.Neurology and therapy · 2024Review
- Narrative Review on the Use of Cladribine Tablets as Exit Therapy for Stable Elderly Patients with Multiple Sclerosis.Neurology and therapy · 2024Review
- Magnetic Resonance Imaging Evidence Supporting the Efficacy of Cladribine Tablets in the Treatment of Relapsing-Remitting Multiple Sclerosis.CNS drugs · 2024Review
- Real-World Effectiveness of Cladribine for Patients with Multiple Sclerosis: A Sicilian Multicentric Experience (Rewind Study).Current neuropharmacology · 2024Article
- The immunological bases of alemtuzumab as induction-therapy in pediatric-onset multiple sclerosis.Frontiers in immunology · 2024Review
- Multiple sclerosis in a patient with Takayasu's Arteritis: A case report.Caspian journal of internal medicine · 2024Article
- Sustained effects on immune cell subsets and autoreactivity in multiple sclerosis patients treated with oral cladribine.Frontiers in immunology · 2024Article
- Article
- Transcriptome alterations in peripheral blood B cells of patients with multiple sclerosis receiving immune reconstitution therapy.Journal of neuroinflammation · 2023Article
- Oral Cladribine Impairs Intermediate, but Not Conventional, Monocyte Transmigration in Multiple Sclerosis Patients across a Model Blood-Brain Barrier.International journal of molecular sciences · 2023Article
- Multiple Sclerosis: Inflammatory and Neuroglial Aspects.Current issues in molecular biology · 2023Review
- Alemtuzumab following natalizumab is more effective in adult-onset than paediatric-onset multiple sclerosis.Therapeutic advances in neurological disorders · 2023Article
- Immune reconstitution following alemtuzumab therapy is characterized by exhausted T cells, increased regulatory control of proinflammatory T cells and reduced B cell control.Frontiers in immunology · 2023Article
- Practical Guidance on the Use of Cladribine Tablets in the Management or Relapsing Multiple Sclerosis: Expert Opinion from Qatar.Degenerative neurological and neuromuscular disease · 2023Review
- Cytokine Secretion Dynamics of Isolated PBMC after Cladribine Exposure in RRMS Patients.International journal of molecular sciences · 2022Article
Corrections and comments
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Whereas drugs used for maintenance/escalation therapy do not maintain their beneficial effect after cessation of therapy, some new highly effective therapies can show prolonged treatment effects after a short treatment course. Such therapies have been named pulsed immune reconstitution therapies or pulsed immunosuppressive therapies, and typical representatives are alemtuzumab and cladribine. Autologous haematopoietic stem cell transplantation could be considered as the strongest immune reconstitution therapy. Both alemtuzumab and cladribine induce depletion of lymphocytes, and a common mechanism of action is preferential depletion of class-switched and unswitched memory B-cells. Whereas CD-19+ B-lymphocytes repopulate within 6 months, CD4+ T-cells repopulate at a slower rate, taking 1-2 years to reach the lower level of normal. In general, the depletion of lymphocytes is more profound and the repletion of T-cells is slower after alemtuzumab than after cladribine treatment. Both drugs have a strong effect on relapses and magnetic resonance imaging (MRI) activity, and reduce disability worsening. The therapeutic effect is maintained beyond the period of active treatment in a large proportion of patients, which is best documented for alemtuzumab. Adverse effects include reactivation of latent infections such as tuberculosis and risk of herpes zoster. The main disadvantage in alemtuzumab-treated patients is the risk of secondary immune-mediated disorders. Pulsed immune reconstitution therapy is an option as initial therapy in relapsing-remitting multiple sclerosis patients with high disease activity and in patients on treatment with another disease-modifying therapy with significant relapse and/or MRI activity.
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