Cladribine use trend in Latin America: the changes in patient profile impact in the drug effectiveness

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发表日期：

2024年9月11日

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Berenice A. Silva,
Alejandra Heriz,
Jeremías Ayerbe,
Luciana Lázaro,
Magdalena Casas,
Pablo López,
Verónica Tkachuk,
María Eugenia Balbuena,
Débora Nadur,
Susana Liwacki,
Geraldine Luetic,
Marcos Burgos,
Federico Casales,
Agustina Piedrabuena,
Edgar Carnero Contentti,
Agustina Zárate,
Gisela Zanga,
Judith Steinberg,
Carolina Mainella,
Darío Tavolini,
Javier Hryb,
Felisa Leguizamón,
Fátima Pagani Cassará,
Gustavo José,
Paula Carrizo,
Pedro Nofal,
Belén Luis,
Cecilia Pita,
Jimena Míguez,
Ricardo Alonso

摘要

Introduction

Cladribine was approved for Multiple Sclerosis (MS) in our country in 2018. A previous study by our group showed that its use among high efficacy therapies options has been increasing along the years. Objective: to analyze the cladribine use trend across time since its approval.

Method

A retrospective cohort study was performed. People with MS (pwMS) treated with cladribine were included. Two periods were defined: P1 = 2018 – 2020 and P2 = 2021 – 2023. A comparative analysis was carry out between P1 and P2 to assess the trend of use, clinical/demographic characteristics, and effectiveness.

Results

One hundred ninety- seven people with MS (pwMS) were included, mean EDSS: 2.2 ± 3.08, 72.6% female, mean age: 35.2 ± 9 years, mean disease duration: 6.6 ± 5.6 years, mean time lapse under cladribine: 26.1 ± 12.4 months. Regarding patient profile, we found significant differences between P1 and P2 in the MS evolution (p = 0.001) and EDSS ( p = 0.018) prior to initiation of cladribine. In the individualized analysis by year, we found a decrease in relapse number in the year prior to starting cladribine (p = 0.02). A higher proportion of No Evidence of Disease Activity (NEDA) was found in patients treated at P2 compared to those treated at P1 (p < 0.001).

Conclusion

An earlier use of cladribine achieved a significant increase in reaching NEDA. This learning curve in the use of cladribine allows a better identification of the candidate patient and influences the treatment effectiveness.