Abstract
BackgroundNatalizumab has been used for treatment of rapidly evolving sever relapsing remitting multiple sclerosis (MS) and is associated with risk of progressive multifocal leukoencephalopathy (PML). Patients can switch treatment after two years if JCV antibody-index is positive. One of the alternative treatment options include a weight based adjusted cladribine tablets that have been approved for treatment of highly active relapsing-remitting MS in Europe since 2017.MethodsWe reviewed 20 patients with prior natalizumab-treatment that switched to oral cladribine. The objective for treatment modification was JCV-index positivity. Data was collected regarding MS relapses, disease progression, or any possible adverse events.ResultsPatients started cladribine treatment between 01/2018 and 07/2019 with a follow-up observation period from 3 weeks to 18 months. Treatment was well tolerated and there were no severe opportunistic infections.ConclusionAccording to this review of 20 patients, treatment with cladribine tablets was safe even when used in patients previously treated with natalizumab and at high risk for PML. So far, no serious adverse events other than transient lymphopenia have been observed, especially no cases of PML.j.das@doctors.org.uk
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