Cladribine is a treatment for relapsing MS. Its brand name is Mavenclad.
Who can take cladribine?
You can take cladribine if:
- you have ‘highly active’ relapsing MS. This means you’ve had two or more disabling relapses in the past year and MRI scans show you have more, or bigger, lesions. Guidelines call this ‘rapidly evolving severe relapsing remitting MS’
- despite taking a DMT, you’ve had a relapse in the past year and new or bigger lesions can be seen on your MRI scans
COVID-19, cladribine and MRI scans
Because of COVID-19 it may now be harder to get MRI scans. So since February 2021 neurologists can prescribe cladribine where it’s appropriate but without the need for one. Once it becomes easier to get MRI scans again, neurologists are likely to go back to needing scans before they can give people this drug.
How does cladribine work?
Cladribine kills certain types of blood cells made by your immune system. These white blood cells (or lymphocytes) are called T and B cells.
These cells normally attack viruses and bacteria that get into your body. But in MS they attack the covering (called myelin) around the nerves in your brain and spinal cord. Cladribine stops these cells, especially the B cells, from getting into your brain and spinal cord, so they can’t damage the nerves there.
You take this drug as a tablet in two courses. Each treatment course consists of two treatment weeks, one at the beginning of the first month and one at the beginning of the second month. This is then repeated a year later. Hopefully the two courses will control your MS and you won’t need any more treatment.
How well does cladribine work?
MS drugs can be put into three groups based on how well they control it. The effectiveness of cladribine is classed as 'good'. This puts it between the DMTs classed as 'high' effectiveness and those classed as 'moderate'. This is based on how much it reduces relapses and slows down how fast people's disability gets worse.
In a large trial:
Relapses dropped by 58% compared to a placebo (a dummy pill with no drug in it)
This means that during the two years of the trial, on average, people saw a drop of 58% in the number of relapses they had. This was compared to people who took the placebo. During the two years after the trial ended this drop was kept up.
Disability getting worse was slowed by 33% compared to the placebo
This means that in the trial, on average, people saw a drop of 33% in the risk of their disability getting worse (compared to people who took the dummy pill).
Over the two years the trial lasted, nearly half of people (46%) had no signs their MS was still active.
What are the side effects of cladribine?
Cladribine doesn’t weaken your immune system as much as some other MS drugs. So the risk of getting infections isn’t as high as with some DMTs.
The most common side effect is a drop in the number of your white blood cells that fight infections (lymphopenia). This is seen in about one in four to one in three people. Cladribine is meant to make this happen but this drop can last a long time and be severe.
Other side effects can include a slightly higher risk of getting headaches, colds, and infections caused by the herpes viruses. This includes the skin rash shingles, which one in 50 people on the drug get. You’ll be vaccinated against some infections like chicken pox before you take cladribine.
An earlier study seemed to show a higher risk of cancer but we now know this isn't the case.