Cladribine to be available for more people with relapsing MS

The new recommendation says anyone with relapsing remitting MS who's having relapses or new disease activity visible on MRI scans (known as active MS) may be eligible for cladribine. Previously, it was only prescribed to people with more severe active relapsing remitting MS (known as ‘highly active’ MS).

In December, NICE made the interim decision not to recommend cladribine for people with active relapsing remitting MS. We told them why expanding the eligibility would make a difference. We’re really pleased they reversed the decision based on all the responses received. England and Wales will be the first countries in Europe to recommend cladribine for more people with active relapsing MS.

What is cladribine?

Cladribine is a disease modifying therapy (DMT) for relapsing MS. Its brand name is Mavenclad. You take it 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.

Cladribine works by killing certain types of blood cells made by your immune system. These white blood cells (or lymphocytes) are called T and B cells.

What's changing?

NICE’s recommendation will mean more people with active relapsing remitting MS in England and Wales can take cladribine, if their doctor thinks it’s suitable. Active MS means your immune system is attacking nerves in your brain or spinal cord. Signs of this can be a relapse or new or growing lesions on your MRI scan.

Until now, cladribine has only been prescribed to people with ‘highly active’ relapsing remitting MS. This is a more severe sort of active MS than 'active MS'.

If you're unsure if you'll be eligible for cladribine under the new guidance, speak to your MS specialist. The new guidance doesn’t affect anyone already on a course of cladribine.

Will it be available where I live?

The new NICE guidance applies to England and Wales and will be published in April.

Northern Ireland will make a decision after the final guidance is published. The Scottish Medicines Consortium is currently assessing whether to make cladribine available to more people with MS in Scotland.

What does this mean for our MS community?

Clare Elgar was diagnosed with highly active relapsing MS after experiencing loss of function in her right arm. Her MS causes a range of symptoms including tingling and heavy legs. She took a two year course of cladribine.

Clare says: "I truly believe cladribine has been the key to my MS stabilising. Since starting the treatment in 2021, I've experienced no relapses. Being able to take the treatment at home meant I could maintain my day-to-day routine and not have to travel to hospital. I’m thrilled the new criteria will give others like me the opportunity to benefit from this. I’m beyond excited to know more people will have the chance to share in this success and lead a much better life with MS."

Our Head of Policy, Laura Thomas, adds: “Cladribine is self-administered. So this decision could particularly benefit people who’d struggle to go into hospital regularly, like younger working-age adults. It will also benefit patients considering starting a family, as it’s safe to get pregnant six months after the final course of treatment. This is less restrictive than many other DMT options. We’re so glad more people with MS will now be able to choose an effective treatment which suits their lifestyle.”

We also want to know if more people could benefit from cladribine. That’s why we’re helping to fund a clinical trial, ChariotMS. This trial is testing whether cladribine can help people with advanced MS maintain the use of their arms and hands.

Find out more about ChariotMS