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Ginestal R, Rubio-Terrés C, Morán OD, Rubio-Rodríguez D, Los Santos HD, Ordoñez C, Sánchez-Magro I. Cost-effectiveness of cladribine tablets and dimethyl fumarate in the treatment of relapsing remitting multiple sclerosis in Spain. J Comp Eff Res 2023; 12:e220193. [PMID: 36705064 PMCID: PMC10288949 DOI: 10.2217/cer-2022-0193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/19/2022] [Indexed: 01/28/2023] Open
Abstract
Aim: To analyze the cost-effectiveness of treatment of relapsing remitting multiple sclerosis (RRMS) with cladribine tablets (CladT) and dimethyl fumarate (DMF) from the perspective of the Spanish National Health System (NHS). Methods: A probabilistic Markov model (second-order Monte Carlo simulation) with a 10-year time horizon and annual Markov cycles was performed. Results: CladT was the dominant treatment, with lower costs (-74,741 € [95% CI: -67,247; -85,661 €]) and greater effectiveness (0.1920 [95% CI: -0.1659; 0.2173] QALY) per patient, compared with DMF. CladT had a 95.1% probability of being cost-effective and a 94.1% chance of being dominant compared with DMF. Conclusion: CladT is the dominant treatment (lower costs, with more QALYs) compared with DMF in the treatment of RRMS in Spain.
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Affiliation(s)
- Ricardo Ginestal
- Hospital Clínico San Carlos, Neurology Department, C/ Prof Martín Lagos, 28040 Madrid, Spain
| | | | - Olga Durán Morán
- Merck, SLU, C/ María de Molina, 40, 28006 Madrid, Spain, an affiliate of Merck KGaA
| | | | - Heidi De Los Santos
- Merck, SLU, C/ María de Molina, 40, 28006 Madrid, Spain, an affiliate of Merck KGaA
| | - Cristina Ordoñez
- Merck, SLU, C/ María de Molina, 40, 28006 Madrid, Spain, an affiliate of Merck KGaA
| | - Isabel Sánchez-Magro
- Merck, SLU, C/ María de Molina, 40, 28006 Madrid, Spain, an affiliate of Merck KGaA
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Aglas-Leitner FT, Juillard P, Juillard A, Byrne SN, Hawke S, Grau GE, Marsh-Wakefield F. Mass cytometry reveals cladribine-induced resets among innate lymphoid cells in multiple sclerosis. Sci Rep 2022; 12:20411. [PMID: 36437270 PMCID: PMC9701791 DOI: 10.1038/s41598-022-24617-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/17/2022] [Indexed: 11/29/2022] Open
Abstract
Here we present a comprehensive mass cytometry analysis of peripheral innate lymphoid cell (ILC) subsets in relapsing/remitting MS (RRMS) patients prior to and after onset of cladribine tablets (CladT). ILC analysis was conducted on CyTOF data from peripheral blood mononuclear cells (PBMC) of MS patients before, 2 and 6 months after onset of CladT, and non-MS controls. Dimensionality reduction was used for immunophenotyping ILC subsets. CladT reduced all ILC subsets, except for CD56bright NK cells and ILC2. Furthermore, CD38+ NK cell and CCR6+ ILC3 were excluded from CladT-induced immune cell reductions. Post-CladT replenishment by immature ILC was noted by increased CD5+ ILC1 proportions at 2 months, and boosted CD38-CD56bright NK cell numbers at 6 months. CladT induce immune cell depletion among ILC but exclude CD56bright NK cells and ILC2 subsets, as well as CD38+ NK cell and CCR6+ ILC3 immunophenotypes. Post-CladT ILC expansions indicate ILC reconstitution towards a more tolerant immune system phenotype.
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Affiliation(s)
- F. T. Aglas-Leitner
- grid.1013.30000 0004 1936 834XVascular Immunology Unit, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia ,grid.22937.3d0000 0000 9259 8492Medical University of Vienna, Spitalgasse 23, Vienna, Austria
| | - P. Juillard
- grid.1013.30000 0004 1936 834XVascular Immunology Unit, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - A. Juillard
- grid.1013.30000 0004 1936 834XVascular Immunology Unit, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - S. N. Byrne
- grid.452919.20000 0001 0436 7430Centre for Immunology and Allergy Research, The Westmead Institute for Medical Research, Sydney, Australia ,grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, Australia
| | - S. Hawke
- grid.1013.30000 0004 1936 834XVascular Immunology Unit, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia ,Central West Neurology and Neurosurgery, Orange, Australia
| | - G. E. Grau
- grid.1013.30000 0004 1936 834XVascular Immunology Unit, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - F. Marsh-Wakefield
- grid.1013.30000 0004 1936 834XVascular Immunology Unit, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia ,grid.248902.50000 0004 0444 7512Liver Injury & Cancer Group, Centenary Institute, Sydney, Australia ,grid.1013.30000 0004 1936 834XHuman Cancer & Viral Immunology Laboratory, The University of Sydney, Sydney, Australia ,grid.248902.50000 0004 0444 7512Centenary Institute, Sydney, NSW Australia
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Meuth SG, Bayas A, Kallmann B, Linker R, Rieckmann P, Wattjes MP, Mäurer M, Kleinschnitz C. Long-term management of multiple sclerosis patients treated with cladribine tablets beyond year 4. Expert Opin Pharmacother 2022; 23:1503-1510. [PMID: 35930260 DOI: 10.1080/14656566.2022.2106783] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Oral cladribine is a highly effective pulsed selective immune reconstitution therapy licensed for relapsing multiple sclerosis (RMS) since 2017. A full treatment course comprises two treatment cycles given 1 year apart, followed by two treatment-free years. The management of cladribine-treated patients beyond year 4 needs to be addressed as patients have now passed the initial 4 years since European Medical Agency approval. AREAS COVERED A panel of neurologists and a neuroradiologist experienced in MS treatment/monitoring evaluated clinical trial data and real-world evidence and proposed recommendations for the management of cladribine-treated patients beyond year 4. EXPERT OPINION Continuous monitoring of disease activity during the treatment-free period is important. Subsequent management depends on the presence or absence of inflammatory disease activity, determined in the absence of consistent guidelines via practice-driven neurological decision criteria. Persisting or newly occurring inflammatory disease activity is an indication for further treatment, i.e. either re-initiation of cladribine or switching to another highly effective disease-modifying therapy. The decision to retreat or switch should be based on clinical and radiological evaluation considering disease course, treatment history, and safety aspects. In the absence of disease activity, either retreatment can be offered, or the treatment-free period can be extended under structured monitoring.
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Affiliation(s)
- Sven G Meuth
- Klinik für Neurologie des Universitätsklinikums Düsseldorf, Düsseldorf, Germany
| | - Antonios Bayas
- Klinik für Neurologie und Klinische Neurophysiologie, Medizinische Fakultät, Universität Augsburg, Augsburg, Germany
| | | | - Ralf Linker
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Peter Rieckmann
- Abteilung für Neurologie, Medical Park Loipl, Regensburg, Germany
| | - Mike P Wattjes
- Department of diagnostic and interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Mathias Mäurer
- Klinik für Neurologie, Juliusspital Würzburg Klinikum Würzburg Mitte gGmbH, Würzburg, Germany
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