…thylation (Schreiner & Miravalle. J CNS Dis 2012;4:1-14; free full text at www.ncbi.nlm.nih.gov/pmc/articles/PMC3619698/pdf/jcnsd-4-2012-001.pdf). This may be relevant to efficacy, as noted above, and to safety. Hypermethylation of tumour suppressor genes is known to promote some malignancies through gene silencing. The hypomethylating effects of cladribine have been demonstrated in leukemic cell lines (Wyczechowska et al. Biochem Pharmacol 2003;6…

…s studies have identified alterations in microbiome species in MS patients compared to healthy controls (Jangi et al. Nat Commun 2016;7:12015; Miyake et al. PLoS One 2015;10:e0137429). These alterations were associated with variations in the expression of genes involving interferon and NF-kappaB signalling in T cells and monocytes. Also noteworthy is that vitamin D, as well as some disease-modifying therapies used in MS (e.g. glatiramer acetate, d…

…name (Mavenclad). In June 2017, Mavenclad received a positive nod from the Committee for Medicinal Products for Human Use (CHMP), and forwarded its recommendation for approval to the EMA. A decision is expected in September. Cladribine tablets is currently in review with Health Canada, and is expected to become available for the treatment of RRMS in the next few months. Addressing safety concerns The chief safety concern of regulators in 2009 was…