Interesting paper on the mode of action of Ibrutinib and idealisb. This might explain some of the clinical manifestations of treatment, and would support the idea of combining one of these drugs with another drug.
In summary in a culture setting outside the body these researchers showed that the inhibitor drugs didnt actually kill the CLL cells very much. What they did do was inhibit their multiplication.
So, to actually see an elimination of CLL it makes theoretical sense that you may want to combine a drug like Ibrutinib with one that actually kills lymphocytes like say Rituxamab. The idea would be that the two drugs would work synergistically and hopefully in a stronger way. No wonder drug combinations are being investigated in trials like the FLAIR trial (UK only, other combination trials available elsewhere). This makes me feel even more like at least exploring FLAIR when it comes to me needing treatment.
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