Based on the recent COVID-19 vaccine data; vaccine responses are likely to be maintained with cladribine compared to ocrelizumab or other anti-CD20 therapies.
I am so glad that you have written something regarding Cladribine and the cancer consideration that is in an easy to understand synopsis and that gives some needed perspective. This was more eloquently presented here than in much of the information that I have seen. Thank you Dr. G
If a person had been on Tysabri previously would that limit them from taking cladribine in the future? I know you’ve mentioned before that DMT’s can imprint on the immune system and affect future treatment choices.
No not at all. What you need to be aware of is taking some of your risk of PML, albeit it low, forward onto cladribine. However, as cladribine allows normal immune surveillance of the CNS and is not a chronic immunosuppressive agent the risk of PML is very low.
I’m seriously considering switching from Tysabri to Mavenclad
I don’t think my tolerance of Tysabri (daily headaches) and PML risk helps my anxiety.
Is a switch to Mavenclad from Tysabri considered a “medium” efficacy drug choice? Seeing as how Tysabri is up there with the highest (Lemtrada and hsct being the best)
Would I expect a worse outcome? I’m meeting my Neuro next month to discuss options.
Thanks! I’m thinking perhaps cladribine may be an option for me. This helps me be on top of my care. Not all of us are as lucky to have an outstanding neurologist.
I took Cladribine in 2019 and 2020 which was my first DMT. It is amazing to think how progressive my Neurologist was for recommending it. Every time, I read one of your newsletter related to cladribine, I feel so grateful. NEDADI since 2019 🎉🎉🎉
I would like to hear more about cladribine in general. I am taking fingolimod and my impression is that cladribine is about as effective, as safe or safer (both on cancer and long term immune suppression) and may be better at treating disability progression (as opposed to just reducing relapses). I know fingolimod cessation is not a walk in the park but I'm considering broaching it with my neuro.
Dr Giovannoni, I wonder if you could give me some advice on what you'd do for my situation. I'm on ocrelizumab and have just had an abnormal smear test result. I have cancelled my upcoming infusion while I wait for a colposcopy, but am wondering what the best course of action would be in the various scenarios that could happen afterwards. Do you agree it would be sensible to stay off ocrelizumab, taking Aubagio or Copaxone instead (what about Tecfidera or a more effective medication?) and wait to hopefully clear the HPV infection I presumably have. After that I could get the Gardasil vaccine (I did get the earliest iteration of this before in 2008) and then restart Ocrevus or Mavenclad?
I don't like the idea of being on a lower efficacy medicine, but am also concerned about cervical cancer. My neurologist did not provide me with any information other than saying we would wait to see the colposcopy results.
I agree may be worth waiting to see what the Gynaecologist has to say after the colposcopy. Unfortunately, the first generation of HPV vaccination only covered 4 strains and about two-thirds of oncogenic strains. If you are shown to be at high-risk of CIN or cervical cancer it would make sense not to be on chronic immunosuppression.
Thank you! I really appreciate your answer (and, to be honest, your online presence in general!). Fingers crossed for an OK result on the colposcopy, but I think I'll probably stay off Ocrevus for a while whatever happens.
I am glad to have seen this post. I was diagnosed with MS in May 2022 after my first relapse in suspected Optic Neuritis and due to be starting cladribine in September. I also test positive for HPV in my smears but have had no or low grade cell changes up until now. One neurologist has suggested cladribine and another has suggested ofatumumab. I am also stuck between the cancer risk yet the convenience of cladribine compared with staying on ofatumamab continuously. I was told I was not eligible for Lemtrada. Any kind of advice would be greatly appreciated.
I'm really hacked off. I received my latest smear test result yesterday and it turns out I'm positive for HPV, despite not having any sexual partners since before my last (negative) smear. Yes sad I know, but it's not been at the forefront of my mind during a global pandemic!
I have now learned that non-sexual transmission is possible. But it still feels incredibly unfair at a time when I'm still not really going anywhere or doing anything! Could being on Tecfidera have made me more vulnerable?
I've had a couple of cold viruses lately too though managed to avoid Covid so far.
I am so glad that you have written something regarding Cladribine and the cancer consideration that is in an easy to understand synopsis and that gives some needed perspective. This was more eloquently presented here than in much of the information that I have seen. Thank you Dr. G
Great information.
If a person had been on Tysabri previously would that limit them from taking cladribine in the future? I know you’ve mentioned before that DMT’s can imprint on the immune system and affect future treatment choices.
No not at all. What you need to be aware of is taking some of your risk of PML, albeit it low, forward onto cladribine. However, as cladribine allows normal immune surveillance of the CNS and is not a chronic immunosuppressive agent the risk of PML is very low.
Is that an issue even if you are Jc Negative?
I’m seriously considering switching from Tysabri to Mavenclad
I don’t think my tolerance of Tysabri (daily headaches) and PML risk helps my anxiety.
Is a switch to Mavenclad from Tysabri considered a “medium” efficacy drug choice? Seeing as how Tysabri is up there with the highest (Lemtrada and hsct being the best)
Would I expect a worse outcome? I’m meeting my Neuro next month to discuss options.
Thanks! I’m thinking perhaps cladribine may be an option for me. This helps me be on top of my care. Not all of us are as lucky to have an outstanding neurologist.
I took Cladribine in 2019 and 2020 which was my first DMT. It is amazing to think how progressive my Neurologist was for recommending it. Every time, I read one of your newsletter related to cladribine, I feel so grateful. NEDADI since 2019 🎉🎉🎉
I would like to hear more about cladribine in general. I am taking fingolimod and my impression is that cladribine is about as effective, as safe or safer (both on cancer and long term immune suppression) and may be better at treating disability progression (as opposed to just reducing relapses). I know fingolimod cessation is not a walk in the park but I'm considering broaching it with my neuro.
I will be covering all the DMTs as individual Newsletters over time including cladribine. The following Newsletters may be of help to you.
https://gavingiovannoni.substack.com/p/case-study-switching-from-ocrelizumab-e79
https://gavingiovannoni.substack.com/p/case-study-no-regrets
thanks!
Dr Giovannoni, I wonder if you could give me some advice on what you'd do for my situation. I'm on ocrelizumab and have just had an abnormal smear test result. I have cancelled my upcoming infusion while I wait for a colposcopy, but am wondering what the best course of action would be in the various scenarios that could happen afterwards. Do you agree it would be sensible to stay off ocrelizumab, taking Aubagio or Copaxone instead (what about Tecfidera or a more effective medication?) and wait to hopefully clear the HPV infection I presumably have. After that I could get the Gardasil vaccine (I did get the earliest iteration of this before in 2008) and then restart Ocrevus or Mavenclad?
I don't like the idea of being on a lower efficacy medicine, but am also concerned about cervical cancer. My neurologist did not provide me with any information other than saying we would wait to see the colposcopy results.
What would you do in this situation?
Many thanks,
I agree may be worth waiting to see what the Gynaecologist has to say after the colposcopy. Unfortunately, the first generation of HPV vaccination only covered 4 strains and about two-thirds of oncogenic strains. If you are shown to be at high-risk of CIN or cervical cancer it would make sense not to be on chronic immunosuppression.
Thank you! I really appreciate your answer (and, to be honest, your online presence in general!). Fingers crossed for an OK result on the colposcopy, but I think I'll probably stay off Ocrevus for a while whatever happens.
I am glad to have seen this post. I was diagnosed with MS in May 2022 after my first relapse in suspected Optic Neuritis and due to be starting cladribine in September. I also test positive for HPV in my smears but have had no or low grade cell changes up until now. One neurologist has suggested cladribine and another has suggested ofatumumab. I am also stuck between the cancer risk yet the convenience of cladribine compared with staying on ofatumamab continuously. I was told I was not eligible for Lemtrada. Any kind of advice would be greatly appreciated.
I'm really hacked off. I received my latest smear test result yesterday and it turns out I'm positive for HPV, despite not having any sexual partners since before my last (negative) smear. Yes sad I know, but it's not been at the forefront of my mind during a global pandemic!
I have now learned that non-sexual transmission is possible. But it still feels incredibly unfair at a time when I'm still not really going anywhere or doing anything! Could being on Tecfidera have made me more vulnerable?
I've had a couple of cold viruses lately too though managed to avoid Covid so far.
Not sure. But all screening tests are 100% sensitive and hence the initial negative test could have been a false negative test.