Switching from Fingolimod/Natalizumab to Cladribine Without Rebound

Rebound of Multiple Sclerosis Disease Activity After Switching from Fingolimod or Natalizumab to Cladribine Tablets: Real World Experience from the Arabian Gulf

In a real-world analysis from the Arabian Gulf, 13 patients with relapsing multiple sclerosis (RMS) transitioned from fingolimod or natalizumab to cladribine tablets (CladT). Reasons included side effects, John Cunningham Virus positivity, or treatment optimization. Washout periods averaged 56 days for fingolimod and 61 days for natalizumab. Results showed no rebound disease activity or significant lymphocytopenia following the switch, highlighting cladribine’s safety and efficacy as an immune reconstitution therapy (IRT) for highly active RMS.