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Abstract Details

Short term efficacy and safety outcomes following treatment with cladribine tablets in patients switching from lymphocyte depleting or sequestering DMDs
Multiple Sclerosis
MS and CNS Inflammatory Disease Posters (7:00 AM-5:00 PM)
212

To characterize the profile of lymphopenia and investigate disability outcomes in patients switched from high efficacy lymphocyte depleting or sequestering agents to cladribine tablets (CT).
As the number of available therapies in MS increases, knowledge about how to safely switch between therapies is increasingly important.  Although CT can be initiated once peripheral lymphocytes are within the normal range, it is currently unknown how previous treatment with high efficacy DMTs may affect lymphocyte population kinetics, and real-world outcomes data is limited.  
A cohort of 163 patients with MS received a cumulative dose of 1.75 mg/kg oral cladribine over 2 treatment weeks. Descriptive statistics were used to analyze baseline characteristics at time of cladribine initiation, including prior use of DMTs. Overall lymphocytes and subsets were measured at baseline, and over 12 months after starting therapy with cladribine. Expanded Disability Status Scale (EDSS) was captured at 6 monthly intervals

Of the total cohort, 128 patients switched to cladribine with a treatment gap of <6 months, the most common immediate prior DMTs were fingolimod (40%), ocrelizumab (16%) and natalizumab (16%). 5 patients were previously treated with cladribine. All ALCs were greater or equal to 0.6 x106 at month 7, and no cases of grade 4 lymphopenia were recorded.  92 patients recorded EDSS scores from both baseline and 12 months after initiation of cladribine. From those, 43.5% showed an improved status (average EDSS at baseline; 4.35 vs 12 months after cladribine initiation; 3.35), 35.9% of patients had no change in EDSS, and 20.7 % showed disability regression. No serious adverse effects were recorded.

Oral cladribine has a predictable effect on lymphopenia. The magnitude of the effect differs depending on baseline levels, with the overall nadir similar. The majority of the patients in the cohort showed an improvement or stabilization of EDSS over 12 months.

Authors/Disclosures
Daniel T. O'Neill, MD (Liverpool Hospital)
PRESENTER 		Dr. O'Neill has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merk. Dr. O'Neill has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbvie.
No disclosure on file
Suzanne J. Hodgkinson, MD, MBBS, PhD, FRACP The institution of Dr. Hodgkinson has received research support from MERCK. The institution of Dr. Hodgkinson has received research support from Atara. The institution of Dr. Hodgkinson has received research support from Biogen . The institution of Dr. Hodgkinson has received research support from Genzyme. The institution of Dr. Hodgkinson has received research support from ROCHE. The institution of Dr. Hodgkinson has received research support from Novartis.