title: Safety and tolerability of cladribine tablets in multiple sclerosis: the CLARITY (CLAdRIbine Tablets treating multiple sclerosis orallY) study.
abstract: BACKGROUND
  Cladribine is a synthetic deoxyadenosine analogue in development as an oral multiple sclerosis (MS) therapy.
  
  
  OBJECTIVE
  To report in detail the safety findings from the 96-week, phase III, double-blind CLARITY study, which evaluated treatment with cladribine tablets in relapsing-remitting MS.
  
  
  METHODS
  A total of 1,326 patients were randomized 1:1:1 to two short-course regimens of cladribine tablets (3.5 or 5.25 mg/kg cumulative dose over 96 weeks) or placebo. Safety assessments included monitoring for adverse events (AEs), routine physical and neurologic examinations and frequent laboratory parameter assessments.
  
  
  RESULTS
  Of the randomized patients, 88.6% completed treatment with cladribine tablets versus 86.3% with placebo. Lymphopenia was the most commonly reported AE in patients treated with cladribine tablets and was anticipated based on the mechanism of action. The incidence of infections was 48.3% with cladribine tablets and 42.5% with placebo, with 99.1% and 99.0% rated mild-to-moderate by investigators. Herpes zoster infections developed in 20 (2.3%) cladribine-treated patients; all cases were dermatomal. There were no herpes zoster infections in the placebo group. Nine (1.0%) patients experienced events related to uterine leiomyomas in the cladribine tablets groups versus one (0.2%) with placebo. Three isolated cases of malignancy were reported in cladribine-treated patients during the study; a fourth was reported during post-study surveillance. A pre-malignant cervical carcinoma in situ was also reported. The incidence of malignancies during the study did not exceed the expected rate in a population standardized for country, gender and age.
  
  
  CONCLUSIONS
  The safety and tolerability profile observed in the CLARITY study together with the reported efficacy support the potential for cladribine tablets as an MS therapy.
authors.affiliation: University of Medicine and Dentistry, New Jersey Medical School, Newark, NJ 07101, USA. cooksd@umdnj.edu
authors.forename: S
authors.initials: S
authors.lastname: Cook
authors.forename: P
authors.initials: P
authors.lastname: Vermersch
authors.forename: G
authors.initials: G
authors.lastname: Comi
authors.forename: G
authors.initials: G
authors.lastname: Giovannoni
authors.forename: K
authors.initials: K
authors.lastname: Rammohan
authors.forename: P
authors.initials: P
authors.lastname: Rieckmann
authors.forename: P Soelberg
authors.initials: PS
authors.lastname: Sørensen
authors.forename: A
authors.initials: A
authors.lastname: Hamlett
authors.forename: M
authors.initials: M
authors.lastname: Miret
authors.forename: J
authors.initials: J
authors.lastname: Weiner
authors.forename: V
authors.initials: V
authors.lastname: Viglietta
authors.forename: B
authors.initials: B
authors.lastname: Musch
authors.forename: S J
authors.initials: SJ
authors.lastname: Greenberg
mesh_terms: D000284:Administration, Oral; D000328:Adult; D017338:Cladribine / Q000008:administration & dosage / Q000009:adverse effects*; D004185:Disability Evaluation; D004311:Double-Blind Method; D005060:Europe; D006562:Herpes Zoster / Q000139:chemically induced; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D008231:Lymphopenia / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis / Q000188:drug therapy*; D009369:Neoplasms / Q000139:chemically induced; D009460:Neurologic Examination; D010808:Physical Examination; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D017338:Cladribine