Disease activity after two courses of cladribine: experience of up to 7.5 years follow up

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 94; no. Suppl 1; p. A30
• Main Authors: Allen-Philbey, Kimberley, MacDougall, Amy, Adams, Ashok, Giovannoni Gavin, Sharmilee, Gnanapavan, Monica, Marta, Mathews Joela, Turner, Ben, Baker, David, Schmierer, Klaus
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.11.2023
• Subjects: Immunotherapy; Magnetic resonance imaging
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/JNNP-2023-ABN.89

BackgroundCladribine is an immunotherapy for people with multiple sclerosis (pwMS). Whilst many pwMS do not require retreatment after completing a standard dosing schedule, disease activity resumes in others.AimsTo investigate whether baseline characteristics, including degree of lymphocyte reduction, and total or weight-adjusted drug dose, were associated with re-emerging disease activity.MethodsDemographics, clinical, laboratory and magnetic resonance imaging data of pwMS who received two courses of cladribine were extracted from the health record. To assess associations of predictor variables with time to new disease activity, a series of Cox proportional hazards models were fitted.ResultsOf our total cohort (n=264) 236 pwMS received two courses of cladribine. Median follow-up was 3.5 years (IQR:2.9,4.3) from the last administration. Re-emerging disease activity occurred in 57/236 (24%). Twenty-two/236 received a third course of cladribine 37 months (median;IQR:31.7,42.1), and 22/236 other immunotherapies 19 months (13.0,30.2) after their second course of cladribine, respectively. Thirteen/236 were yet to receive immunotherapy. Hazard models indicated association between re-emerging disease activity and (i) baseline MRI activity (ii) dose of cladribine administered at the second course.ConclusionsRe-emerging disease activity was associated with high baseline MRI activity and low dose second treatment course.