Cladribine
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Lymphopenia: 2 case reports In a case report, a 29-year-old man and a 61-year-old woman were described, who developed lymphopenia during treatment with cladribine for relapsing-remitting multiple sclerosis (RRMS) [routes, dosages and outcomes not stated]. Patient 1: The 29-year-old man was diagnosed with RRMS in May 2018. He started receiving cladribine tablets in July 2018. He received re-dosing of cladribine in July 2019. Blood tests in January 2020 (at the age of 29-years) revealed grade 3 lymphopenia secondary to cladribine with lymphocyte level of 390 lymphocytes/µL with reduced levels of CD4+ lymphocytes (66 /µL), CD8+ lymphocytes (39 /µL) and CD20+ lymphocytes (39 /µL). In March 2020, while he was in Switzerland, he presented with dysgeusia, fever, diarrhoea and anosmia. Hence, he was quarantined at home without testing. He recovered fully in few days using paracetamol as needed. In June 2020, he was found to have anti- SARS-CoV-2 IgG antibodies. Patient 2: The 61-year-old woman, who had hypertension and dyslipidaemia, had been diagnosed with RRMS in July 1994. She had been initially treated with interferon beta 1a and then with fingolimod in January 2017 and finally switched to cladribine tablets in December 2019. The first year dosing of cladribine was completed in January 2020. In February 2020 (at the age of 61-years), blood tests revealed grade 1 lymphopenia secondary to cladribine with lymphocyte level of 860 lymphocytes/µL. In May 2020, she tested positive for SARS-CoV-2 RNA. She did not present with any symptoms and was found negative on two following tests in June 2020. In July 2020, she was found to have anti- SARS-CoV-2 IgG antibodies. De Angelis M, et al. Mild or no COVID-19 symptoms in cladribine-treated multiple sclerosis: Two cases and implications for clinical practice. Multiple Sclerosis and Related 803500602 Disorders 45: 102452, Oct 2020. Available from: URL: http://doi.org/10.1016/j.msard.2020.102452
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Reactions 12 Sep 2020 No. 1821
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