Evidence map›Paper›PMID 36396449›Full record

ArticleNeurology(R) neuroimmunology & neuroinflammation2023

CLIPPERS Responsive to Cladribine as a Durable Steroid-Sparing Agent.

Simon Thebault, Hailey Bergman, Harold L Atkins, Mark S Freedman, John Brooks

Open access · goldAbstract readCase Reports
In one paragraph

Article in Neurology(R) neuroimmunology & neuroinflammation, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.4field-weighted citation impact, top 37% 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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 3 citations in OpenAlex.

  1. Article
  2. 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

5 authors at 1 institution in 1 country.

Simon ThebaultFrom The Ottawa Hospital and University of Ottawa (S.T., H.B., H.L.A., M.S.F., J.B.), ON; and Perelman School of Medicine and University of Pennsylvania (S.T.), PA. thesdx@gmail.com.ORCID 0000-0003-0395-3395
Hailey BergmanFrom The Ottawa Hospital and University of Ottawa (S.T., H.B., H.L.A., M.S.F., J.B.), ON; and Perelman School of Medicine and University of Pennsylvania (S.T.), PA.
Harold L AtkinsFrom The Ottawa Hospital and University of Ottawa (S.T., H.B., H.L.A., M.S.F., J.B.), ON; and Perelman School of Medicine and University of Pennsylvania (S.T.), PA.ORCID 0000-0002-6168-3939
Mark S FreedmanFrom The Ottawa Hospital and University of Ottawa (S.T., H.B., H.L.A., M.S.F., J.B.), ON; and Perelman School of Medicine and University of Pennsylvania (S.T.), PA.ORCID 0000-0003-1255-9701
John BrooksFrom The Ottawa Hospital and University of Ottawa (S.T., H.B., H.L.A., M.S.F., J.B.), ON; and Perelman School of Medicine and University of Pennsylvania (S.T.), PA.
Hospital of the University of Pennsylvania · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveWe report a case of chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) who achieved durable and steroid-free remission after IV cladribine.

methodsA 25 year-old man presented with progressively worsening headaches, polydipsia, dysarthria, diplopia and vertigo, and obtundation requiring respiratory support. CSF revealed lymphocytosis, and MRI revealed a perivascular pattern of punctate enhancement involving the pons. An extensive workup for inflammatory, autoimmune, infective, and malignant explanations was unrevealing. He responded dramatically to steroids, compatible with CLIPPERS as a diagnosis of exclusion. Attempts to wean prednisone over the ensuing year resulted in 2 clinical relapses and persistent punctate enhancement. Given significant steroid side effects, steroid-sparing agents were considered.

resultsIV cladribine IV (0.0875 mg/kg adjusted body weight daily × 4 days at 0, 4, 8, and 16 months) was selected, given its favorable side effect profile including lower risks of malignancy and infertility and the potential for long-lasting effects. The only side effect was short-term fatigue at the time of infusion. At 20 months after cladribine initiation, he was able to wean-off prednisone altogether. Now at 33 months, he remains in clinical and MRI remission. DISCUSSION: Cladribine is a rational candidate steroid-sparing treatment for presumed neurologic autoimmune conditions such as CLIPPERS. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that cladribine is a steroid-sparing treatment consideration in CLIPPERS.

Indexed as

Central Nervous System DiseasesCladribineAdultHumansMagnetic Resonance ImagingMalePonsPrednisoneCladribinePrednisone

Identifiers

PMID36396449
PMCPMC9747139
OpenAlexW4309512444

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

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.