Evidence map›Paper›PMID 39055049›Full record

ArticleJournal of central nervous system disease2024

Real-world effectiveness of cladribine as an escalation strategy for MS: Insights from the Czech nationwide ReMuS registry.

Pavel Potuznik, Jiri Drahota, Dana Horakova, Marek Peterka, Aneta Mazouchova, David Matyas, Zbysek Pavelek, Marta Vachova, Eva Recmanova, Ivana Stetkarova and 11 more

Abstract read
In one paragraph

Article in Journal of central nervous system disease, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

21 authors.

Pavel PotuznikDepartment of Neurology, Faculty of Medicine and University Hospital in Pilsen, Charles University, Plzen, Czech Republic.ORCID https://orcid.org/0000-0001-8241-7798
Jiri DrahotaDepartment of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic.ORCID https://orcid.org/0000-0003-3416-2094
Dana HorakovaDepartment of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic.
Marek PeterkaDepartment of Neurology, Faculty of Medicine and University Hospital in Pilsen, Charles University, Plzen, Czech Republic.ORCID https://orcid.org/0000-0002-0588-4592
Aneta MazouchovaEndowment Fund IMPULS, Prague, Czech Republic.
David MatyasDepartment of Neurology, Faculty of Medicine and University Hospital Hradec Kralove, Charles University, Prague, Czech Republic.
Zbysek PavelekDepartment of Neurology, Faculty of Medicine and University Hospital Hradec Kralove, Charles University, Prague, Czech Republic.ORCID https://orcid.org/0000-0002-1772-8781
Marta VachovaDepartment of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic.ORCID https://orcid.org/0000-0002-8158-724X
Eva RecmanovaDepartment of Neurology, Tomas Bata Hospital, Zlin, Czech Republic.
Ivana StetkarovaDepartment of Neurology, 3rd Faculty of Medicine, Charles University in Prague and Hospital Kralovske Vinohrady, Prague, Czech Republic.
Jana LibertinovaDepartment of Neurology, Second Faculty of Medicine and Motol University Hospital, Charles University, Prague, Czech Republic.
Jan MaresDepartment of Neurology, Faculty of Medicine, Palacky University and University Hospital Olomouc, Olomouc, Czech Republic.
Pavel StouracDepartment of Neurology, University Hospital and Masaryk University Brno, Brno, Czech Republic.
Marketa GrunermelovaDepartment of Neurology, Thomayer Hospital, Prague, Czech Republic.
Alena MartinkovaDepartment of Neurology, Hospital Pardubice, Pardubice, Czech Republic.
Jana AdamkovaDepartment of Neurology, Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic.
Pavel HradilekDepartment of Neurology, University Hospital Ostrava and Medical Faculty, Ostrava University, Ostrava, Czech Republic.
Radek AmpapaDepartment of Neurology, Hospital of Jihlava, Jihlava, Czech Republic.
Michal Dufek1st Department of Neurology, University Hospital U Svate Anny and Masaryk University Brno, Brno, Czech Republic.
Eva Kubala HavrdovaDepartment of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic.
Dominika StastnaDepartment of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic.ORCID https://orcid.org/0000-0003-2418-4847

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Cladribine, a selective immune reconstitution therapy, is approved for the treatment of adult patients with highly active multiple sclerosis (MS). Objectives: Provide experience with cladribine therapy in a real-world setting. Methods: This is a registry-based retrospective observational cohort study. First, using data from the Czech nationwide registry ReMuS, we analysed patients who initiated cladribine from September 1, 2018 to December 31, 2021. Second, we analysed a subgroup of patients who initiated cladribine between September 1, 2018 to June 30, 2020, thus possessing a follow-up period of at least 2 years. We evaluated demographic and MS characteristics including disease-modifying therapies (DMTs) before and after cladribine administration, relapses, Expanded Disability Status Scale (EDSS), and adherence. Results: In total, 617 patients (335 with follow-up of at least 2 years) started cladribine therapy in the study period (mean age 37.0, mean disease duration 8.4 years, 74.1% females). In most cases, cladribine was administered as a second-line drug, a total of 80.7% had been escalated from a platform DMT. During 2 years before cladribine initiation, the average annualised relapse rate (ARR) was .67. Following cladribine initiation, the ARR decreased to .28 in the first year and .22 in the second year. Overall, across the entire two-year treatment period, 69.0% of patients were relapse-free and the average ARR was .25. As for EDSS development, the median baseline EDSS was 2.5 and remained stable even after 24 months. The adherence to treatment ranged of around 90%. Conclusion: This nationwide study confirms the efficacy of cladribine in real-world settings, especially in patients who are not treatment-naïve. In addition, the study shows an exceptionally high adherence rate, a finding that underscores the invaluable role of cladribine, but also the value of registry-based studies in capturing real-world clinical practice.

Indexed as

adherenceannualised relapse rateCladribineexpanded disability status scalehigh-efficacy disease-modifying therapymultiple sclerosis

Identifiers

PMID39055049
PMCPMC11271105

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.