Comparative Effectiveness of Cladribine and S1P Receptor Modulators in Treatment-Naive Relapsing-Remitting MS

How does cladribine compare with sphingosine-1-phosphate receptor modulators (S1PRMs) in treatment-naive patients with relapsing-remitting multiple sclerosis?In this comparative effectiveness research study of 950 propensity score–matched treatment-naive patients with at least 12 months (median, 25 months) of follow-up, cladribine and S1PRMs demonstrated comparable relapse rates, magnetic resonance imaging activity, and no evidence of disease activity with 3 components loss, with cladribine associated with a significantly lower risk of confirmed disability worsening, likely driven by a reduction in progression independent of relapse activity events, and with indications of reduced clinical activity control beyond 36 months.These findings suggest cladribine may provide greater short-term protection against disability progression, with a possible need for redosing or treatment switch to sustain disease control beyond 3 years.

Corresponding Author: Shalom Haggiag, MD, Centro Sclerosi Multipla, Dipartimento di Neuroscienze, Azienda Ospedaliera San Camillo Forlanini, Circonvallazione Gianicolense 87, 00152, Rome, Italy (shaggiag@scamilloforlanini.rm.it).

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