European experience of cladribine tablets in elderly patients with multiple sclerosis: Could it be the last treatment?

IF 2.3 Q2 CLINICAL NEUROLOGY

Multiple Sclerosis Journal - Experimental, Translational and Clinical Pub Date : 2025-03-17 eCollection Date: 2025-01-01 DOI:10.1177/20552173251321810

Jérôme de Seze, Chiara Zecca, Giovanni Castelnovo, Xavier Ayrignac, Patrick Vermersch, Claudio Gobbi, Giulia Mallucci, Clarisse Carra-Dallière, Pierre Labauge, Kévin Bigaut, Laurent Kremer, Nicolas Collongues, Livia Lanotte, Eric Thouvenot, Christine Ernon, Dominique Dive

{"title":"European experience of cladribine tablets in elderly patients with multiple sclerosis: Could it be the last treatment?","authors":"Jérôme de Seze, Chiara Zecca, Giovanni Castelnovo, Xavier Ayrignac, Patrick Vermersch, Claudio Gobbi, Giulia Mallucci, Clarisse Carra-Dallière, Pierre Labauge, Kévin Bigaut, Laurent Kremer, Nicolas Collongues, Livia Lanotte, Eric Thouvenot, Christine Ernon, Dominique Dive","doi":"10.1177/20552173251321810","DOIUrl":null,"url":null,"abstract":"Background: Recent studies support the need for early and intensive disease-modifying treatment (DMT) for patients with multiple sclerosis (PWMS). Abrupt DMT withdrawal may risk disease reactivation. Recent studies showed that MS disease activity was not rare after DMT withdrawal for PWMS aged >45/55 y. Immune reconstitution therapy (IRT) with cladribine tablets (CladT), may be an option for older PWMS who wish to stop DMT.Objective: We retrospectively analysed PWMS aged >45 y who initiated CladT in 6 MS centers in Europe.Results: One hundred and twenty nine PWMS (95 women/34 men, mean age 55.0 +/-7.5y initiated CladT; 83 (64.3%) previously received platform DMT, 35 (27.2%) previously received high efficacy DMT and 11 (8.5%) received CladT as a 1st DMT due to a late onset of MS or to a delayed therapy decision. Mean follow-up was 2.4 y (1-5) on CladT. Only three patient experienced 4 relapses. The first one had 2 relapses after switching from fingolimod with a 2-month interval between treatments. The 2 remaining were naïve patients that had a relapse between the 2 courses of CladT.Conclusion: Last/exit therapy with CladT seems to avoid MS disease reactivation in older PWMS and may be an interesting alternative solution to continue immunosuppression/immunomodulation.","PeriodicalId":18961,"journal":{"name":"Multiple Sclerosis Journal - Experimental, Translational and Clinical","volume":"11 1","pages":"20552173251321810"},"PeriodicalIF":2.3000,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915273/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Multiple Sclerosis Journal - Experimental, Translational and Clinical","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/20552173251321810","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Recent studies support the need for early and intensive disease-modifying treatment (DMT) for patients with multiple sclerosis (PWMS). Abrupt DMT withdrawal may risk disease reactivation. Recent studies showed that MS disease activity was not rare after DMT withdrawal for PWMS aged >45/55 y. Immune reconstitution therapy (IRT) with cladribine tablets (CladT), may be an option for older PWMS who wish to stop DMT.

Objective: We retrospectively analysed PWMS aged >45 y who initiated CladT in 6 MS centers in Europe.

Results: One hundred and twenty nine PWMS (95 women/34 men, mean age 55.0 +/-7.5y initiated CladT; 83 (64.3%) previously received platform DMT, 35 (27.2%) previously received high efficacy DMT and 11 (8.5%) received CladT as a 1^st DMT due to a late onset of MS or to a delayed therapy decision. Mean follow-up was 2.4 y (1-5) on CladT. Only three patient experienced 4 relapses. The first one had 2 relapses after switching from fingolimod with a 2-month interval between treatments. The 2 remaining were naïve patients that had a relapse between the 2 courses of CladT.

Conclusion: Last/exit therapy with CladT seems to avoid MS disease reactivation in older PWMS and may be an interesting alternative solution to continue immunosuppression/immunomodulation.

查看原文本刊更多论文

老年多发性硬化症患者服用克拉德滨片的欧洲经验：这可能是最后的治疗方法吗？

背景：最近的研究支持对多发性硬化症（PWMS）患者进行早期和强化疾病改善治疗（DMT）的必要性。突然停用DMT可能有疾病重新激活的风险。最近的研究表明，年龄在45岁/55岁的PWMS患者停用DMT后，MS疾病活动并不罕见。免疫重建治疗（IRT）与克拉德里滨片（CladT）可能是希望停止DMT的老年PWMS的一种选择。目的：我们回顾性分析了欧洲6个多发性硬化症中心年龄在45岁左右并开始CladT治疗的多发性硬化症患者。结果：PWMS 129例（女性95例/男性34例，平均年龄55.0 +/-7.5岁）首发CladT；83例（64.3%）先前接受过平台DMT， 35例（27.2%）先前接受过高效DMT， 11例（8.5%）由于MS晚发或延迟治疗决定而接受CladT作为第一次DMT。CladT的平均随访时间为2.4 y（1-5）。仅有3例复发4次。第一组患者在使用芬戈莫德后复发2次，治疗间隔2个月。其余2例为naïve患者，在2个疗程CladT之间复发。结论：CladT的最后/退出治疗似乎避免了老年PWMS的MS疾病再激活，可能是继续免疫抑制/免疫调节的有趣替代解决方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊