Novel Oral Therapy for MS: AAN Data Updates

Ravi Dukkipati, MD: The results of studies surrounding oral cladribine, or Mavenclad, presented at AAN [American Academy of Neurology Annual Meeting] 2020 were interesting, compelling, and encouraging. I see oral cladribine representing a broad-spectrum agent that is conceivably high efficacy and well suited for a broad range of patients, both relapsing-remitting as well as secondarily progressive. I see oral cladribine being used effectively for patients with mild, moderate, and more active disease. It’s an oral therapy, short course, and easy to administer with relatively low monitoring requirements. Certainly in this COVID-19 [coronavirus disease 2019] era, I think it does play a significant role.

The adverse-event profile or tolerability of oral cladribine, in my experience as well as the data in the pivotal trials, is favorable. The most common adverse effects, occurring at an incidence of more than 20%, are transient and fairly mild. They include headache, upper respiratory tract symptomatology, and of course transient lymphocyte depletion, which is an expected outcome given the mechanism of this drug.

Initiating and maintaining a patient on Mavenclad has been fairly easy for me during this pandemic. There are some basic prerequisite blood tests that can be done 1 time and are fairly easy to do. The 10 days of initial-year therapy are coordinated with MS [multiple sclerosis] LifeLines. I believe the drug is mailed directly to the patient at their home. Nursing will then provide support virtually or by telephone. Beyond that, the patient is required to have a CBC [complete blood count] with differential performed at regular intervals 2 months and 6 months following administration. This has been a very easy drug for me to use before COVID and certainly during COVID.

There were data presented at AAN 2020 centering on or involving ocrelizumab and long-term efficacy. The data confirmed that long-term ocrelizumab has significant prolonged effects in terms of slowing down disability progression in addition to reducing relapses and suppressing MRI activity.

These data, regarding long-term use of ocrelizumab presented at AAN 2020, are certainly encouraging. They help those of us who have had patients on this drug since its launch 2 or 3 years ago. They give us confidence in continuing this drug long term. There are still some questions that I have surrounding B-cell depletion and risk of certain infections. That’s being worked on in ongoing studies. Nonetheless, these data are encouraging in that I don’t necessarily see my prescribing habits changing. I am able to provide patients with reassurance—that is, those patients who have been on ocrelizumab for several years should have continued positive results moving forward.