Co-morbidities are a feature of age..as you get older you slowly get all sorts of other conditions….I once went to some student presentations were students have to present on current and future treatments for a condition they had selected autoimmune hepatitis because their mother had it. My heart bled when they said they got steroids and may get azathioprine…this drug is about as good as beta interferon in MS…. I sort of heard the same story about people who had neuromyelitis optica in the UK. NICE were not going to approave the expensive drug. The neuro was also offering azathioprine….when I asked about cladribine they the neuro said it was too dangerous as it was killing…Which rock was this person living under I thought….Cladribine kills B cells and so it would be a good bet to try in any condition where anti-CD20 depleting antibody works.
So it comes are no surprise to me that in people getting other autoimmunities as well as MS then there is a chance of a response. These recent papers show gut diseases such as Crohns (lower intestine) and ulcerative colitis (upper gut) may respond to cladribine. As the patent of cladribine expires and the price drops people will start to use it off-label in usual conditions lacking treatments….They could use subcutaneous cladribine, which is a fraction of the cost.
Lu J, Brownlee WJ. Cladribine: A useful treatment option in multiple sclerosis patients with autoimmune comorbidities. Mult Scler. 2025 Nov 30:13524585251396293.
Barbuti E, Pozzilli C, Borriello G, Petracca M. Addressing autoimmune comorbidities in multiple sclerosis: A case report of ulcerative colitis remission in a patient treated with cladribine tablets. Mult Scler. 2025 Nov 30:13524585251396258
Dauby S, Dive D, Hansen I, Lommers E, Bernard V, Lamproye A, Maquet P, Louis E, Vieujean S. Cladribine monotherapy in a patient with coexisting Crohn’s disease and multiple sclerosis. Mult Scler. 2025 Nov 30:13524585251390859.
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Source: multiple-sclerosis-research.org