Cladribine and Other Agents in Aging Multiple Sclerosis

At the 2024 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, NeurologyLive sat down with MS expert Donald Negroski, MD, to discuss several of the top presentations and data on treatment switches and aging in MS. Negroski provided an overview of various presentations, offering his clinical perspective and how findings may impact care going forward.

In this specific conversation, the neurologist gave insight on a real-world analysis which revealed that cladribine (Mavenclad; EMD Serono), an FDA-approved disease-modifying therapy, was well tolerated with no new safety signals in an aging population with MS where comorbid conditions and immunosenescence may increase. Negroski commented on the positive results from the analysis, and the need to continue to evaluate marketed drugs for this aging cohort.

Transcript edited below for clarity.

Donald Negroski, MD: First of all, if you look at the prevalence of MS, it's becoming more frequent. The prevalence rate is higher as the population ages, mainly because of the baby boomers; Ages 40 to 45 to 60, that cohort of patients, they're starting to age. In the study, when I looked at my patients on oral cladribine, I divided them into two groups: patients less than 50 [years old] or 50 and above. We looked at various parameters in terms of safety, lymphocyte dynamics, infection rates, etc. to see if aging patients performed somewhat differently than younger patients with oral cladribine. In terms of efficacy, MRI parameters, and side effects, we really didn't find any trends.

The trend that we did find is that at year two, when you redose cladribine, you'll get a drop in the lymphocyte count, which was a little bit lower in the older patient population, and then it kind of goes back up. But despite that, it really didn't affect the efficacy or side effect profile observed in our study. That's why this aging patient population is so key to understand. In clinical trials, the cutoffs are typically 60 maybe 65 [years old] with oral cladribine. But practicing in Florida, I have older patients that are playing golf, pickleball, and all that stuff at 70-72 years old. And so there's this concept of biological age and chronological age, which is one of the big topics coming up in the MS community. Clinicians are trying to understand the difference between biological age and chronological age in terms of efficacy of MS drugs and tolerability and side effects.