Cladribine Tablets and Relapsing–Remitting Multiple Sclerosis: A Pragmatic, Narrative Review of What Physicians Need to Know

Al-Jumah, Mohamed; Alkhawajah, Mona; Qureshi, Shireen; Althubaiti, I.; Ayoub, Omar; Bohlega, Saeed; Bushnag, Areej; Cupler, Edward; Daif, Abdulkader; Boghdady, Ahmed El; Hassan, Ahmed; Malik, Yaser Al; Saeedi, Jameelah; Al-Shamrany, Fawzia; Shosha, Eslam; Rieckmann, Peter

doi:10.1007/s40120-020-00177-5

Cited by 7 publications

(8 citation statements)

References 27 publications

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“…Intensive monitoring requirements or the need to visit hospitals for infusions of some DMTs adds to the burden of treatment with some DMTs [ 78 ]. The IRT approach renders these issues moot [ 18 , 36 , 79 , 80 ]: for example, for a patient who responds to treatment with cladribine tablets there is no need for regular intakes of treatment or for continued monitoring beyond 6 months of the last dose (or the recovery of lymphocytes, if this takes longer). This expert group supported this principle, as their support for the use of cladribine tablets in CLARITY-like patients (one relapse in the previous year or 2 relapses in the previous 2 years) was stronger if the patient’s lifestyle preferences mitigated against the use of continuous treatment or if the patient was likely to be non-compliant with this approach.…”

Section: Discussionmentioning

confidence: 99%

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

Inshasi

Al-Fahad²,

Alsaadi³

et al. 2021

Neurol Ther

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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

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Section: Discussionmentioning

confidence: 99%

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

Inshasi

Al-Fahad²,

Alsaadi³

et al. 2021

Neurol Ther

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“…Efficacy and the safety/tolerability and monitoring burdens of individual DMDs are key aspects to consider when prescribing a DMD, irrespective of pregnancy status or plans. A full account of these is beyond the scope of this review and has been reviewed elsewhere [17][18][19].…”

Section: Methods and Objectivesmentioning

confidence: 99%

Disease-Modifying Drugs and Family Planning in People with Multiple Sclerosis: A Consensus Narrative Review from the Gulf Region

et al. 2020

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Most disease-modifying drugs (DMDs) are contraindicated in pregnancy. Management of MS is especially challenging for pregnant patients, as withdrawal of DMDs leave the patient at risk of increased disease activity. We, a group of experts in MS care from countries in the Arab Gulf, present our consensus recommendations on the management of MS in these patients. Where possible, a patient planning pregnancy can be switched to a DMD considered safe in this setting. Interferon β now can be used during pregnancy, where there is a clinical need to maintain treatment, in addition to glatiramer acetate. Natalizumab (usually to 30 weeks’ gestation for patients with high disease activity at high risk of relapse and disability progression) may also be continued into pregnancy. Cladribine tablets and alemtuzumab have been hypothesised to act as immune reconstitution therapies (IRTs). These drugs provide a period of prolonged freedom from relapses for many patients, but the patient must be prepared to wait for up to 20 months from initiation of therapy before becoming pregnant. If a patient becomes pregnant while taking fingolimod, and requires continued DMD treatment, a switch to interferon β or natalizumab after a variable washout period may be prescribed, depending on the level of disease activity. Women who wish to breastfeed should be encouraged to do so, and interferon β may also be used during breastfeeding. There is a lack of data regarding the safety of using other DMDs during breastfeeding.

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“…Cladribine tablets (oral administration) and alemtuzumab (given by infusion) are the two agents currently available that are believed to act as IRTs, and which are not administered continuously. Both are considered high-efficacy DMDs [ 19 , 25 , 26 ].…”

Section: Disease-modifying Drugs and Pregnancymentioning

confidence: 99%

Family Planning for People with Multiple Sclerosis in Saudi Arabia: an Expert Consensus

Aljumah

Malik

Alkhawajah

et al. 2021

Multiple Sclerosis International

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More than half of all patients with multiple sclerosis (MS) in the Kingdom of Saudi Arabia (KSA) are women of childbearing age. Raising a family is an important life goal for women in our region of the world. However, fears and misconceptions about the clinical course of relapsing-remitting MS (RRMS) and the effects of disease-modifying drugs (DMDs) on the foetus have led many women to reduce their expectations of raising a family, sometimes even to the point of avoiding pregnancy altogether. The increase in the number of DMDs available to manage RRMS and recent studies on their effects in pregnancy have broadened management options for these women. Interferon beta now has an indication in Europe for use during pregnancy (according to clinical need) and can be used during breastfeeding. Glatiramer acetate is a further possible option for women with lower levels of RRMS disease activity who are, or about to become, pregnant; natalizumab may be used up to 30 weeks in patients with higher levels of disease activity. Where possible, physicians need to support and encourage women to pursue their dream of a fulfilling family life, supported where necessary by active interventions for RRMS that are increasingly evidence based.

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Cladribine Tablets and Relapsing–Remitting Multiple Sclerosis: A Pragmatic, Narrative Review of What Physicians Need to Know

Cited by 7 publications

References 27 publications

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

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

Disease-Modifying Drugs and Family Planning in People with Multiple Sclerosis: A Consensus Narrative Review from the Gulf Region

Family Planning for People with Multiple Sclerosis in Saudi Arabia: an Expert Consensus

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