The landscape of multiple sclerosis (MS) management is rapidly evolving in last few years . With the introduction of new MS therapies the neurologists and the patients are able to make treatment decisions based on many factors including , disease severity, modes of administration as well as efficacy and safety profiles. Oral Cladribine (MAVENCLAD), is a synthetic small molecule which selectively targets B and T lymphocytes resulting in their transient reduction. It has been suggested that Oral Cladribine is classified as immune reconstitution therapy (IRT), because of its impact on key cellular components of the immune system. Oral Cladribine was launched in United Arab Emirates (UAE) in Feb 2018.
To study and present the real life experience of oral Cladribine in UAE. To present the clinical profile of patients selected , medications switched from , side effects and clinical outcome of patients started on oral cladribine .
Clinical data from all patients who have received oral Cladribine for treatment of Multiple sclerosis in UAE was collected and analyzed.
Total of 88 patients, have been initiated on oral Cladribine for relapsing remitting Multiple sclerosis since in the period from June 2018 till January 2020 in UAE. 30 patients have completed the 2 year dose and rest have taken only one course till Jan 2020. Mean age at treatment initiation was 34 years (range 23- 54years). Average duration of Multiple sclerosis was 7.5 years (range2-20years). Average number of disease modifying agents prior to Cladribine were 1.4 (range 0-4 agents). Average EDSS was 2.4 (range 0-7). 37% were naïve, 29% were switched from Fingolimod, 12% from Natalizumab, 10.4 % from Teriflunomide, 10% from dimethyl fumarate and 3% from interferons. Mild transient headache was observed in 6 patients during first few days which did not require medications. There was no grade 4 lymphopenia, grade 3 lymphopenia was observed in 1 patient , 3 patients had grade 2 lymphopenia and 72 had grade 1 lymphopenia at month3 , all except 4 ,become grade 0 by month 7 . By month 12 only 1 had persistent grade 2 lymphopenia. 1 patient had a relapse after 2 months of first year treatment and 1 patient had persistent MRI activity end of first year. I patient had to stop therapy as she became pregnant after 6 months of first year course. No patient had progression in EDSS score
Oral Cladribine (MAVENCLAD) is a safe effective and well tolerated medication for the treatment of Multiple sclerosis especially for those who have had an inadequate response to, or are unable to tolerate, one or more therapies for relapsing remitting Multiple Sclerosis .