Oral Cladribine B-cell Study

Queen Mary University of London10 enrolled

Overview

To study the impact of cladribine on peripheral and intrathecal B-cell, plasma cells, T cells and Tregs

Primary: To quantify the temporal changes of memory B cells (CD19+/CD27+/IgD-/+), plasmablasts (CD19-/CD138+/CD38+) and T cells (CD4/CD45RA-/+, CCR7-/+, CD8+/CD45RA-/+/CCR7-/+), Tregs (CD4/CD8)/CD25+/CD127-/Fox3 P+) in the peripheral venous blood of pwMS with RRMS over 96w of treatment with oral cladribine. These will be compared to the populations of non-memory or class-switched B cells (immature/transitional B cells CD10+/CD38+/CD19+, immature regulatory B cells CD10+/CD38+/CD19+/CD24+/IL-10+, mature B cells CD10-/CD38+/CD19+). Secondary: 1. To study the effects of oral cladribine on: 1. CSF OCBs and free immunoglobulin kappa and lambda light chain levels (FLC). 2. CSF markers of inflammation, in particular CXCL-13 and urine markers of inflammation (neopterin). 3. CSF markers of neuroaxonal damage, in particular free neurofilament light chains. 4. On the peripheral repertoire B-cells (immunoglobulin) and T-cells (T cell receptor) and plasma cells (soluble receptors). 2. To compare CSF OCB positivity and CSF light chain levels with a contemporary control group of alemtuzumab treated pwMS (historical data). Tertiary: 1. To compare B and T cell repertoire with a contemporary control group of alemtuzumab treated pwMS (historical data). 2. To evaluate the effect of changes in the immune cell profile on clinical measures of disability, MRI activity and PROMS.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Multiple Sclerosis

Eligibility

Sex: ALL

Medical Language ↔ Plain English

Inclusion Criteria: * Patients with MS who are being treated with oral cladribine at Barts Health NHS Trust will be approached to participate in this study. * Patients must be willing and able to undergo lumbar punctures * Patients who are OCB positive in their CSF (previous diagnostic lumbar puncture) Exclusion Criteria: * Ineligible for oral cladribine under NHS England prescribing guidelines and those participating in MAGNIFY-MS study (cladribine tablets in active MS) * Unsuitable to have a lumbar puncture, for example spinal deformity, tethered cord syndrome or the use of aspirin or anticoagulants, and those unable to comply with study requirements, including frequency of visits and lumbar punctures. * Presence of comorbidities in which the administration of cladribine is contraindicated. * Abnormal baseline investigations (WBC\<3 x 10\*9/l, lymphocytes \<1.0 x 10\*9/l, neutrophil count \<1.5 x 10\*9/l, platelet count \<100 x 10\*9, haemoglobin \<110g/l, LFT\>/3x upper limit of normal of site reference ranges, potassium \<2.8mmol/l or \>5.5mmol/l, sodium \<125 mmol/l, creatinine \>130 umol/l)

Locations (1)

Barts Health NHS Trust

London, United Kingdom

Outcomes

Primary Outcomes

Percent Change in Class-switched Memory B Cells From Baseline to Week 96 nh

Percent change from baseline to Week 96 in class-switched memory B cells (CD19+/CD27+/IgD-) in participants with RRMS treated with oral cladribine.

Time frame: Baseline to week 96

Percent Change in Non Class-switched Memory B Cells From Baseline to Week 96

Percent change from baseline to Week 96 in non class-switched memory B cells (CD19+/CD27+/IgD+) in participants with RRMS treated with oral cladribine.

Time frame: Baseline to week 96

Percent Change in Plasmablast From Baseline to Week 96

Percent change from baseline to Week 96 in plasmablasts (CD19+/CD27+/CD38+) in participants with RRMS treated with oral cladribine.

Time frame: Baseline to week 96

Percent Change in Transitional B Cells From Baseline to Week 96

Percent change from baseline to Week 96 in transitional B cells (CD19+ IgD+ CD10+ CD27-) in participants with RRMS treated with oral cladribine.

Time frame: Baseline to week 96

Percent Change in Regulatory B Cells From Baseline to Week 96

Percent change from baseline to Week 96 in regulatory B cells (CD19+/CD24+/CD38+) in participants with RRMS treated with oral cladribine.

Time frame: Baseline to week 96

Percent Change in CD4+ Central Memory T Cells From Baseline to Week 96

Percent change from baseline to Week 96 in CD4+ central memory T cells (CD45RA- CCR7+) in participants with RRMS treated with oral cladribine.

Time frame: Baseline to week 96

Percent Change in CD4+ Naive T Cells From Baseline to Week 96

Data from ClinicalTrials.gov

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Secondary Outcomes

Changes in CSF of κ Free Light Chain (KFLC) From Baseline to Week 48 and Week 96

The CSF κ Free Light Chain (KFLC) Index and λ Free Light Chain (LFLC) Index were measured at baseline, Week 48, and Week 96. KFLC and LFLC concentrations in cerebrospinal fluid and serum were obtained using Optilite. The KFLC Index and LFLC Index were calculated as (CSF FLC / serum FLC) ÷ (CSF albumin / serum albumin). These indices provide quantitative measures of intrathecal free light chain synthesis. Values are continuous laboratory measurements and do not use a score or scale.

Time frame: Baseline to week 96

Change in CSF Oligoclonal Band (OCB) Positivity From Baseline to Week 48 and Week 96

CSF and matched serum samples were analysed for IgG oligoclonal bands using isoelectric focusing followed by immunoblotting. OCB positivity was defined as ≥1 IgG band present in CSF but absent in serum (CSF-restricted bands). Reported values include the number of OCB-positive and OCB-negative participants at each time point (baseline, Week 48, Week 96). Higher values indicate increased intrathecal IgG synthesis

Time frame: Baseline to week 96

Changes in CSF of λ Free Light Chain (LFLC) Index From Baseline to Week 48 and Week 96

Time frame: Baseline to week 96

Change in CSF CXCL-13 Levels From Baseline to Week 96

CXCL-13 concentrations in cerebrospinal fluid (CSF) were measured at baseline, Week 48, and Week 96 using immunoassay methods. Values are continuous laboratory measurements and are reported numerically (mean and standard deviation). No scoring system or clinical scale applies.

Time frame: Baseline to week 96

Change in Urine Neopterin Levels From Baseline to Week 96

Urine neopterin concentrations were measured at baseline, Week 48, and Week 96 using immunoassay methods. Values are continuous laboratory measurements and are reported numerically (mean and standard deviation). No scoring system or clinical scale applied

Time frame: Baseline to week 96

Change in CSF Neurofilament Light Chain (NfL) Levels From Baseline to Week 96

CSF neurofilament light chain (NfL) concentrations were measured at baseline, Week 48, and Week 96 using immunoassay methods. NfL is reported as a continuous laboratory value. Results are presented as numerical measurements (mean and standard deviation). No clinical scoring system or scale applies

Time frame: Baseline to 96 weeks

Change in CSF Soluble CD138 Levels From Baseline to Week 96

Soluble CD138 concentrations in cerebrospinal fluid (CSF) were measured at baseline, Week 48, and Week 96 using immunoassay methods. Values are continuous laboratory measurements and are reported numerically (mean and standard deviation). No clinical scoring system or scale applies.

Time frame: Baseline to week 96

Changes in CSF Cytokine and Chemokine Levels From Baseline to Week 96

Cerebrospinal fluid (CSF) cytokines and chemokines were measured at baseline, Week 48, and Week 96 using immunoassays. Analytes included IFN-γ, IL-10, IL-12p70, IL-13, IL-1β, IL-2, IL-4, IL-5, IL-8, and TNF-α. Values are continuous laboratory measurements and are reported numerically (mean and standard deviation). No clinical scoring system or scale applies. Results for each analyte are presented in separate rows of the results table.

Time frame: Baseline to week 96