Evidence map›Paper›PMID 34370275›Full record

Trial reportAdvances in therapy2021

Long-Term Disease Stability Assessed by the Expanded Disability Status Scale in Patients Treated with Cladribine Tablets 3.5 mg/kg for Relapsing Multiple Sclerosis: An Exploratory Post Hoc Analysis of the CLARITY and CLARITY Extension Studies.

Gavin Giovannoni, Giancarlo Comi, Kottil Rammohan, Peter Rieckmann, Fernando Dangond, Birgit Keller, Dominic Jack, Patrick Vermersch

2 registry-linked trialsOpen access · hybridAbstract readRandomized Controlled Trial
In one paragraph

Trial report in Advances in therapy, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 19 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed, 1 pooled it
3.6field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00213135 phase3completednot on this map

A Phase III, Randomized, Double-blind, Three-arm, Placebo-controlled, Multi-center Study to Evaluate the Safety and Efficacy of Oral Cladribine in Subjects With Relapsing-remitting Multiple Sclerosis (RRMS)

TypeinterventionalSponsorEMD SeronoRan2005 to 2008Enrolled1,326ConditionsMultiple Sclerosis, Relapsing-RemittingArmsCladribine 5.25 mg/kg, Cladribine 3.5 mg/kg, Placebo
NCT00641537 phase3completednot on this map

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)

TypeinterventionalSponsorEMD Serono Research & Development Institute, Inc.Ran2008 to 2011Enrolled867ConditionsRelapsing-Remitting Multiple SclerosisArmsCladribine, Placebo
3 · Its place in the literature

Who cites it

19 citing papers in PubMed, 1 synthesis or guideline pooled it, 34 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Observational
  5. Review
  6. Observational
  7. Article
  8. Identifying Cladribine prescription pattern in MS: an Italian multicentre study.Therapeutic advances in neurological disorders · 2025
    Article
  9. Article
  10. Article
  11. Article
  12. Article
  13. Article
  14. Article
  15. Article
  16. Article
  17. Review
  18. Article
  19. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 6 institutions in 5 countries.

Gavin GiovannoniBlizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark St, Whitechapel, London, E1 2AT, UK. g.giovannoni@qmul.ac.uk.ORCID 0000-0001-9995-1700
Giancarlo ComiCasa di Cura Privata del Policlinico, Università Vita-Salute San Raffaele, Milan, Italy.ORCID 0000-0002-6989-1054
Kottil RammohanMS Research Center, University of Miami School of Medicine, Miami, FL, USA.ORCID 0000-0003-2467-4280
Peter RieckmannDepartment of Neurology, Medical Park Loipl and University of Erlangen, Erlangen, Germany.
Fernando DangondEMD Serono Research and Development Institute, Inc., Billerica, MA, USA.ORCID 0000-0002-6723-4229
Birgit KellerThe healthcare business of Merck KGaA, Darmstadt, Germany.ORCID 0000-0001-6870-8003
Dominic JackMerck Serono Ltd (an affiliate of Merck KGaA, Darmstadt, Germany), Feltham, UK.ORCID 0000-0001-8629-553X
Patrick VermerschUniv. Lille, Inserm U1172 LilNCog, CHU Lille, FHU Precise, Lille, France.ORCID 0000-0003-0997-8817
Merck (Germany) · DEInserm · FROno Pharmaceutical (United States) · USQueen Mary University of London · GBUniversity of Miami · USVita-Salute San Raffaele University · IT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionIn the Cladribine Tablets Treating Multiple Sclerosis Orally (CLARITY) study, cladribine tablets significantly reduced relapse rates and improved findings on magnetic resonance imaging versus placebo in patients with relapsing multiple sclerosis. In the CLARITY Extension study, treatment with cladribine tablets for 2 years followed by placebo for 2 years produced similar clinical benefits to 4 years of cladribine tablets. The objective of this exploratory post hoc analysis was to evaluate long-term disease stability (assessed by the Expanded Disability Status Scale [EDSS] score) after treatment with cladribine tablets.

methodsPatients enrolled into CLARITY Extension who were previously randomized to cladribine tablets 3.5 mg/kg in the CLARITY study were included in this post hoc analysis. Two treatment groups were investigated-patients randomized to cladribine tablets 3.5 mg/kg in CLARITY and thereafter randomized to placebo in CLARITY Extension (the CP3.5 group) or to cladribine tablets 3.5 mg/kg in CLARITY Extension (the CC7 group). In each treatment group, EDSS scores at 6-month intervals, EDSS score improvement/worsening each year, and time to 3- and 6-month confirmed EDSS progression were assessed from CLARITY baseline over 5 years of follow-up (including a variable bridging interval between studies). All analyses are descriptive, and no statistical comparisons were performed for between-treatment group differences.

resultsThe median (95% confidence interval [CI]) EDSS score for patients in the CP3.5 group at 5 years was 2.5 (2.0-3.5) compared with 3.0 (2.5-3.5) at baseline. In the CC7 group, median EDSS score (95% CI) at 5 years was 2.0 (2.0-3.0) compared with 2.5 (2.5-3.0) at baseline. During year 5 for the CP3.5 group, and based on changes in minimum score each year, EDSS score stability was observed in 53.9% of patients, improvement in 21.3%, and worsening in 24.7%. In the CC7 group, EDSS score remained stable in 66.1%, improved in 18.1%, and worsened in 15.8% of patients. Over 70% of patients in both treatment groups did not show 3- or 6-month confirmed EDSS progression at 5 years from CLARITY baseline.

conclusionsThese findings confirm long-term beneficial effects on disability afforded by either the recommended dose of cladribine tablets over 4 years (cumulative dose, 3.5 mg/kg) or a higher cumulative dose.

trial registrationClinicalTrials.gov NCT00213135 (CLARITY); NCT00641537 (CLARITY Extension).

Indexed as

Multiple SclerosisMultiple Sclerosis, Relapsing-RemittingCladribineHumansImmunosuppressive AgentsRecurrenceTabletsCladribineImmunosuppressive AgentsTabletsCladribine tabletsCLARITYCLARITY ExtensionDisease stabilityMultiple sclerosis

Identifiers

PMID34370275
PMCPMC8408069
OpenAlexW3188666067

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.