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. 2024 Dec:92:106145.
doi: 10.1016/j.msard.2024.106145. Epub 2024 Oct 28.

De-escalation from anti-CD20 to cladribine tablets in multiple sclerosis: A pilot study

Rosaria Sacco  1 , Giulio Disanto  1 , Emanuele Pravatà  2 , Giulia Mallucci  1 , Aleksandra Maleska Maceski  3 , Jens Kuhle  3 , Claudio Gobbi  4 , Chiara Zecca  5
Affiliations

De-escalation from anti-CD20 to cladribine tablets in multiple sclerosis: A pilot study

Rosaria Sacco et al. Mult Scler Relat Disord. 2024 Dec.

Abstract

Prolonged treatment with anti-CD20 antibodies can lead to hypogammaglobulinemia and increased infection risk in multiple sclerosis (MS). We investigated switch from anti-CD20 to cladribine as a strategy to prevent immunoglobulin reduction while preserving efficacy. We prospectively analysed serum IgG, IgM, neurofilament light (NfL) and glial fibrillary acidic protein (GFAP) in 44 patients, 14 who were switched from anti-CD20 to cladribine and 30 continuing anti-CD20. Over 1 year, serum IgG, IgM, NfL and GFAP remained stable after switch and similar to patients continuing anti-CD20. More than 90 % of patients remained free of disease activity. Cladribine should be further explored as de-escalating agent from anti-CD20 in MS.

Keywords: Anti-CD20; Cladribine; De-escalation; Immunoglobulins; Neurofilaments.

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Conflict of interest statement

Declaration of competing interest The employer (Department of Neurology, Regional Hospital Lugano (EOC), Lugano, Switzerland) receives financial support from Abbvie, Biogen Idec, Lundbeck, Merck, Novartis Roche, Sanofi, Teva. The submitted work is not related to these agreements.

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