Long‐Term Disease Control Following Completion of Cladribine Treatment in Multiple Sclerosis: Extended Follow‐Up of the CladStop Cohort
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Long-term disease control after the standard two-year cladribine course in multiple sclerosis (MS) remains insufficiently characterized in real-world settings. We evaluated disease control, treatment re-initiation, and safety during extended follow-up of the multicenter CladStop cohort after treatment completion. METHODS: We included 204 patients with relapsing MS who completed the approved two-year cladribine regimen and had ≥ 6 months of follow-up after treatment completion. Time zero ("CladStop") was defined as 24 months after first cladribine dosing. Co-primary endpoints were time to loss of no evidence of disease activity (NEDA-3) and annualized relapse rate (ARR) after CladStop. Kaplan-Meier analyses, multivariable Cox models, and mixed-effects Poisson regression were applied. RESULTS: Mean follow-up after CladStop was 44.2 ± 8.6 months. Overall, 81/204 patients (39.7%) lost NEDA-3. NEDA-3 survival was 82.8% (95% CI 77.8-88.2) at 12 months, 69.6% (95% CI 63.6-76.2) at 24 months, and 56.4% (95% CI 49.2-64.8) at 48 months. Forty-two patients (20.6%) relapsed, with an overall ARR of 0.06 (95% CI 0.04-0.08). Relapse rates decreased over time (rate ratio/year 0.74, 95% CI 0.55-0.999; p = 0.044). MRI activity occurred in 29.9% of patients and 6-month confirmed disability progression in 7.4%. A new DMT was initiated in 40.7% of patients. Relapses during treatment predicted earlier DMT initiation. CONCLUSIONS: Disease control remained durable in many patients after completion of cladribine treatment. However, over 40% initiated subsequent DMT during follow-up, indicating that prolonged treatment-free remission is not universal. Disease reactivation was driven mainly by inflammatory activity rather than disability worsening.
Source: European Journal of Neurology
DOI: 10.1111/ene.70763
Authors: Irene Schiavetti, Alessio Signori, Angela Albanese, Jessica Frau, Eleonora Cocco, Lorena Lorefice, Sonia di Lemme, Roberta Fantozzi, Diego Centonze, Doriana Landi, Girolama Marfia, Elisabetta Signoriello, Giacomo Lus, Chiara Zecca, Claudio Gobbi, Rosa Iodice, Leonardo Malimpensa, Cinzia Cordioli, Diana Ferraro, Francesca Ruscica, Livia Pasquali, Anna Repice, Paolo Immovilli, Maria Teresa Ferrò, Simona Bonavita, Massimiliano Di Filippo, Gianmarco Abbadessa, Flora Govone, Maria Pia Sormani, CladStop Study Group
Institutions: IRCCS Azienda Ospedaliera Metropolitana, University of Genoa, University of Cagliari, Istituto Neurologico Mediterraneo, University of Rome Tor Vergata, University of Campania "Luigi Vanvitelli", Azienda Ospedaliera Universitaria Università degli Studi della Campania Luigi Vanvitelli, Università della Svizzera italiana, Federico II University Hospital, University of Naples Federico II, Sapienza University of Rome, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Azienda Ospedaliero-Universitaria di Modena, Fondazione Istituto G. Giglio di Cefalù, University of Pisa, Azienda Ospedaliero-Universitaria Careggi, Guglielmo da Saliceto Hospital, University of Perugia
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,600
OpenAlex ID: W7224861736