{
  "abstract": "Background and Importance Cladribine is an immunosuppressive drug used in relapsing–remitting multiple sclerosis (RRMS), with an intermittent dosing regimen that allows prolonged disease control. The maintenance of its long-term effect still requires further studies, as some patients need a third cycle.Aim and Objectives Provide real-world data on the long-term use of cladribine.Material and Methods A retrospective analysis was carried out at a tertiary hospital, including patients treated with cladribine between January 2020-August 2025. Patients who received a third cycle of cladribine or who remained without disease-modifying therapy (DMT) from the fourth year after starting treatment were included.Results A total of 31 patients met the inclusion criteria, of whom 18 (58.06%) had received a third cycle. Baseline Expanded Disability Status Scale (EDSS) was available for 14 patients, with a median of 2.5 (interquartile range-IQR-: 1–3.38). The median age at treatment initiation was 41 years (IQR: 35.5–50), and 74.19% of the patients were women. The median time from diagnosis to starting cladribine was 9 years (IQR: 3–14). Of the total patients, three were naïve, and most of the rest (13 patients) had received one prior DMT. Regarding relapses, only two patients experienced a relapse in the first year of treatment, with complete resolution, which allowed continuation with the second cycle; in the second year, one patient presented a relapse. Currently, 13 patients remain without DMT, five of whom have reached 5 years and eight have reached 4 years since starting cladribine treatment. Of the 18 patients who received a third cycle, most did so in the fifth year (10 patients), while the rest did so in the fourth (six patients) and third year (two patients), with a mean of 4.39 years (standard deviation: 0.70). The most common reason for prescribing the third cycle was clinical progression (seven patients).Conclusion and Relevance Most patients had received at least one prior DMT. More than half of the patients required a third cycle after a maintenance period of effect, most frequently in the fifth year from treatment initiation. However, larger studies are needed to better evaluate the effect and long-term use of cladribine.Conflict of Interest No conflict of interest",
  "authors": [
    {
      "affiliations": [
        "Jaen University Hospital, Pharmacy Department, Jaen- andalucia, Spain"
      ],
      "name": "A Plaza-Arbeo"
    },
    {
      "affiliations": [
        "Jaen University Hospital, Pharmacy Department, Jaen- andalucia, Spain"
      ],
      "name": "B Morales Rivero"
    },
    {
      "affiliations": [
        "Jaen University Hospital, Pharmacy Department, Jaen- andalucia, Spain"
      ],
      "name": "MJ Barbero-Hernandez"
    }
  ],
  "title": "4CPS-029 Long-term use of cladribine in multiple sclerosis",
  "uid": "5148087f-388f-57b6-968f-13b652079ca3"
}