AAN 2026 | Switching from natalizumab to cladribine in MS: real-world relapse risk and timing gaps

As I said previously, in the Czech setting, cladribine has been used for a long time as a second-line treatment, although it’s changing now. But what about using cladribine after natalizumab? Is it a good idea? We know that natalizumab is sometimes connected with a rebound effect, something we are really afraid of. And cladribine, it takes some time for cladribine to have enough effect. The increase of effect is slower. So is it safe, is it good enough to allow the patient to be stabilized? For this purpose, we use data again, we use data from the Czech National MS registry, and we found 54 patients who switched from natalizumab to cladribine. In the year before the last dose of natalizumab, about 40% of patients relapsed, and in the year after the first cladribine dose, again about 40% of patients relapsed. Is it good or is it bad? I think this number is quite substantial. But the reason for it is probably that when we looked deeper in the data, we saw that the median time between the last natalizumab dose and first cladribine dose was 75 days. So what to take from this study, what to take from this information? Switching from natalizumab to cladribine can be feasible, I definitely think it’s a possibility, but we need to find our patients, find specific ones who can benefit from this strategy, and we definitely need to make some strategy to shorten the time and to make much more profit for the patient from this.

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