ProfK is a CladLad and has been flying the flag for many years. I put this paper up as it reinforces what I was saying about breaks after anti-CD20. Someone asked me if we will ever get a chemical B cell depleters.
My answer was you already have one…it’s called cladribine. But I said going cold turkey with anti-CD20 will now doubt lead to failures in some and I suggested that this would notably be in people with more active disease at the start of treatment and also in younger people. I said this because it has been seen with other medications, including cladribine and alemtuzumab. Now this study says there is about 25-30% of people who had cladribine that developed disease breakthrough. These people had more active disease before treatment, age was not an influence here. However if you think about anti-CD20 and doing a watch and wait…how many people with fail treatment even when they say on drug..However for the 75% there is real benefit
Yamout B, Shatila A, Inshasi J, Hassan A, Szolics M, Hassan A, Farw A, Beriam B, Ismail G, Zeineddine M. Long-term Real-world Safety and Efficacy of Cladribine Tablets in Patients with Relapsing-Remitting Multiple Sclerosis: The UAE Experience. Mult Scler Relat Disord. 2026 May 8;111:107244. doi: 10.1016/j.msard.2026.107244.
Background: Although oral cladribine received approval for treating relapsing-remitting multiple sclerosis (RRMS), real-world evidence regarding its long-term effectiveness and safety in the United Arab Emirates (UAE) remains limited.
Yamout B, Shatila A, Inshasi J, Hassan A, Szolics M, Hassan A, Farw A, Beriam B, Ismail G, Zeineddine M. Long-term Real-world Safety and Efficacy of Cladribine Tablets in Patients with Relapsing-Remitting Multiple Sclerosis: The UAE Experience. Mult Scler Relat Disord. 2026 May 8;111:107244.
Objective: To evaluate efficacy and safety outcomes of RRMS patients treated with cladribine tablets (CladT) and identify early predictors of response.
Methods: This is a multicenter, observational, retrospective study of RRMS patients treated with CladT from four tertiary MS centers in the UAE. Relapses, disability worsening, occurrence of new or enlarging T2-hyperintense magnetic resonance imaging (MRI) lesions and the proportion of patients achieving no-evidence-of-disease-activity-3 (NEDA-3) status were assessed. Safety outcomes included lymphocyte counts, infections and malignancy. The association between baseline characteristics and outcomes was tested to identify potential predictors of response.
Results: A total of 163 MS patients were included, 120 (73.6%) of whom were females. Patients were treated with CladT, with a median (IQR) follow-up of 2.0 (1.0-2.6) years. A total of 121 (74.2%) patients had received another disease-modifying therapy (DMT) before cladribine. By the end of follow-up, the mean annualized relapse rate decreased by 84.4% (p<0.001). Most patients (91.8%) showed no disability progression, 74.1% had no new MRI activity, and 70.5% achieved NEDA-3. The number of relapses prior to CladT was the only predictor of NEDA-3. Safety outcomes included 7 adverse events (2.5%), with no hospitalizations. One patient developed a malignancy (astrocytoma) 1.2 years after treatment initiation.
Conclusion: Our study results confirm the safety and efficacy profiles of CladT reported in Phase 3 clinical trials and other real-world studies
COI: Multiple
Source: multiple-sclerosis-research.org