Neurol. praxi. 2020;21(1):79-81

Praktické aspekty selektivní rekonstituce imunitního systému v léčbě roztroušené sklerózy

V rámci 33. českého a slovenského neurologického sjezdu, který proběhl na konci listopadu 2019 v Praze, měli účastníci možnost poslechnout si přednášku zaměřenou na mechanizmus účinku perorálního kladribinu (Mavenclad®, Merck KGaA) v léčbě roztroušené sklerózy (RS). Prof. MUDr. Vojtěch Thon, Ph.D., z Přírodovědecké fakulty Masarykovy univerzity v Brně se věnoval vlivu chorobu modifikujících léků na buňky imunitního systému. Ukázal, že podání pulzů perorálního kladribinu vede k selektivnímu přechodnému mírnému až střednímu poklesu počtu B a T lymfocytů, aniž by výrazně ovlivnil počty buněk zodpovědných za vrozenou imunitu. To může být vysvětlením absence zvýšeného rizika bakteriálních infekcí při jeho podávání. Po iniciálním poklesu lymfocytů nastává jejich postupná obnova a dochází k tzv. imunorekonstituci. Z pohledu dynamiky populace lymfocytů jde o stav obdobný autologní transplantaci krvetvorných kmenových buněk (HSCT). Při klinickém rozhodování o očkování pacientů s RS léčených kladribinem proto navrhuje vycházet z doporučení právě pro pacienty po HSCT.

Published: March 30, 2020  Show citation

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Praktické aspekty selektivní rekonstituce imunitního systému v léčbě roztroušené sklerózy. Neurol. praxi. 2020;21(1):79-81.
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    References

    1. Baker D, Herrod SS, Alvarez-Gonzalez C, Zalewski L, Albor C, Schmierer K. Both cladribine and alemtuzumab may effect MS via B-cell depletion. Neurol Neuroimmunol Neuroinflamm. 2017; 4(4): e360. Go to original source... Go to PubMed...
    2. Baker D, Pryce G, Herrod SS, Schmierer K. Potential mechanisms of action related to the efficacy and safety of cladribine. Mult Scler Relat Disord. 2019; 30: 176-186. Go to original source... Go to PubMed...
    3. Comi G, Cook S, Giovannoni G, Rieckamnn P, Sørensen PS, Vermerch P,L Galazka A, Nolting A, Hicking C, Dangond F. Effect of cladribine tablets on lymphocyte reduction and repopulation dynamics in patients with relapsing multiple sclerosis.Mult Scler Relat Disord 2019; 29: 168-174. Go to original source... Go to PubMed...
    4. Cordonnier C, Einarsdottir S, Cesaro S, Di Blasi R, Mikulska M, Rieger C, de Lavallade H, Gallo G, Lehrnbecher T, Engelhard D, Ljungman P; European Conference on Infections in Leukaemia group. European Conference on Infections in Leukaemia group. Vaccination of haemopoietic stem cell transplant recipients: guidelines of the 2017 European Conference on Infections in Leukaemia (ECIL 7). Lancet Infect Dis. 2019; 19(6): e200-e212. Go to original source... Go to PubMed...
    5. Farez MF, Correale J, Armstrong MJ, Rae-Grant A, Gloss D, Donley D, Holler-Managan Y, Kachuck NJ, Jeffery D, Beilman M, Gronseth G, Michelson D, Lee E, Cox J, Getchius T, Sejvar J, Narayanaswami P. Practice guideline update summary: Vaccine- preventable infections and immunization in multiple sclerosis: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology 2019; 93(13): 584-594. Go to original source... Go to PubMed...
    6. Giovannoni G, Comi G, Cook S, Rammohan K, Rieckmann P, Soelberg Sørensen P, Vermersch P, Chang P, Hamlett A, Musch B, Greenberg SJ; CLARITY Study Group. A placebo-controlled trial of oral cladribine for relapsing multiple sclerosis. N Engl J Med 2010; 362: 416-426. Go to original source... Go to PubMed...
    7. Lebrun C, Vukusic S; French Group for Recommendations in Multiple Sclerosis (France4MS) and the Société Francophone de la Sclérose En Plaques (SFSEP). Immunization and multiple sclerosis: Recommendations from the French multiple sclerosis society. Mult Scler Relat Disord. 2019; 31: 173-188. Go to original source... Go to PubMed...
    8. Leist TP, Weissert R. Cladribine: mode of action and implications for treatment of multiple sclerosis.Clin Neuropharmacol 2011; 34: 28-35. Go to original source... Go to PubMed...
    9. Luna G, Alping P, Burman J, Fink K, Fogdell-Hahn A, Gunnarsson M, Hillert J, Langer-Gould A, Lycke J, Nilsson P, Salzer J, Svenningsson A, Vrethem M, Olsson T, Piehl F, Frisell T. Infection Risks Among Patients With Multiple Sclerosis Treated With Fingolimod, Natalizumab, Rituximab, and Injectable Therapies. JAMA Neurol. 2019 Oct 7. [Epub ahead of print]. Go to original source... Go to PubMed...
    10. Segal Y, Shoenfeld Y. Vaccine-induced autoimmunity: the role of molecular mimicry and immune crossreaction. Cell Mol Immunol. 2018; 15(6): 586-594. Go to original source... Go to PubMed...
    11. Sorensen PS, Dangond F, Hicking C, Giovannoni G. Long- -Term Lymphocyte Counts in Patients with RRMS Treated with Cladribine Tablets 3.5 Mg/Kg: Total Lymphocytes, B-, and T-Cell Subsets. Mult Scler J. 2018; 24(Suppl. 1): P084. Go to original source...
    12. Sørensen P. Long-Term Lymphocyte Counts in Patients with Relapsing-Remitting Multiple Sclerosis (RRMS) Treated with Cladribine Tablets 3.5 mg/kg: Total Lymphocytes, B and T Cell Subsets ECTRIMS Online Library. 2017; 200310; P655. Go to original source...
    13. SPC kladribin. www.sukl.cz.
    14. Stuve O, Soerensen PS, Leist T, Giovannoni G, Hyvert Y, Damian D, Dangond F, Boschert U. Effects of cladribine tablets on lymphocyte subsets in patients with multiple sclerosis: an extended analysis of surface markers. Ther Adv Neurol Disord. 2019; 12: 1756286419854986. Go to original source... Go to PubMed...
    15. Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M, Bousvaros A, Dhanireddy S, Sung L, Keyserling H, Kang I; Infectious Diseases Society of America. Infectious Diseases Society of America. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis. 2014; 58(3): 3090318. Go to original source...

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