Position of Cladribine Tablets in the Management of Relapsing-Remitting Multiple Sclerosis: An Expert Narrative Review From the United Arab Emirates

Abstract

The use of immune reconstitution therapies (IRT) in patients with relapsing-remitting multiple sclerosis (RRMS) is associated with a prolonged period of freedom from relapses in the absence of continuously applied therapy. Cladribine tablets is a disease-modifying treatment (DMT) indicated for highly active relapsing multiple sclerosis (MS) as defined by clinical or imaging features. Treatment with cladribine tablets is effective and well tolerated in patients with active MS disease and have a low burden of monitoring during and following treatment. In this article, an expert group of specialist neurologists involved in the care of patients with MS in the United Arab Emirates provides their consensus recommendations for the practical use of cladribine tablets according to the presenting phenotype of patients with RRMS. The IRT approach may be especially useful for patients with highly active MS insufficiently responsive to treatment with a first-line DMT, those who are likely to adhere poorly to a continuous therapeutic regimen, treatment-naïve patients with high disease activity at first presentation, or patients planning a family who are prepared to wait until at least 6 months after the end of treatment. Information available to date does not suggest an adverse interaction between cladribine tablets and COVID-19 infection. Data are unavailable at this time regarding the efficacy of COVID-19 vaccination in patients treated with cladribine tablets. Robust immunological responses to COVID-19 infection or to other vaccines have been observed in patients receiving this treatment, and treatment with cladribine tablets per se should not represent a barrier to this vaccination.

Keywords: Cladribine tablets; Disease-modifying therapy; Multiple sclerosis; United Arab Emirates.

Fig. 1

Potential therapeutic use of cladribine tablets for a newly diagnosed patient with RRMS without prior treatment with a disease-modifying therapy

Fig. 2

Potential therapeutic use of cladribine tablets for a patient with RRMS currently receiving a different disease-modifying therapy

Fig. 3

Minimum washout times following discontinuation of a disease-modifying therapy and administration of cladribine tablets. ^aNote that lymphocytes must be normal before initiating cladribine tablets irrespective of waiting times shown here. ^bAssumes the rapid elimination procedure for teriflunomide is used

Fig. 4

Experts’ perceptions of high-efficacy DMTs for the management of RRMS. Experts scored DMTs according to each attribute from 1 (lowest/worst) to 7 (highest/best) and bars show average rankings. See text for more details