New research presented at the 2026 Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum suggests that cladribine tablets (Mavenclad; EMD Serono) may offer advantages over other commonly prescribed disease-modifying therapies (DMTs) for multiple sclerosis (MS). A comparative study analyzing real-world data indicates that patients treated with cladribine experienced fewer treatment switches, reduced outpatient visits, and lower overall healthcare costs over a four-year period.
The study, involving a large dataset of over 3,000 patients with MS, compared outcomes for those treated with cladribine to those receiving fingolimod (Gilenya; Novartis), dimethyl fumarate (Tecfidera; Biogen), or teriflunomide (Aubagio; Sanofi). Researchers analyzed data from the Komodo Healthcare Map Database, spanning from April 1, 2018, to March 31, 2024, focusing on patients with at least two MS claims recorded at least 30 days apart and at least one claim for one of the four DMTs.
The findings, presented by lead author Ajay S. Gupta, MD, assistant professor of neurology at Indiana University Medical School, revealed a significantly lower rate of treatment switching among patients on cladribine. Only 11% of patients in the cladribine group switched to another DMT, compared to 42% in the fingolimod group, 57% in the dimethyl fumarate group, and 42% in the teriflunomide group. These differences were statistically significant, with odds ratios of 7.05 for fingolimod, 11.27 for dimethyl fumarate, and 6.43 for teriflunomide compared to cladribine.
Beyond treatment adherence, the study also examined healthcare resource utilization. Patients treated with cladribine had comparable rates of emergency department visits and hospitalizations to those receiving other DMTs. However, all-cause outpatient visits were lower in the cladribine group compared to those treated with dimethyl fumarate or teriflunomide, while rates were similar to those observed in the fingolimod cohort.
Perhaps most notably, the analysis demonstrated substantial cost savings associated with cladribine treatment. The average all-cause medical cost per patient per year (PPPY) was $13,377 for those on cladribine, significantly lower than the costs associated with fingolimod ($23,450), dimethyl fumarate ($25,390), and teriflunomide ($23,294). Total costs PPPY were also lower for cladribine ($53,007) compared to fingolimod ($67,207) and teriflunomide ($60,000), with dimethyl fumarate showing a non-significant difference ($57,479).
These findings align with results from another study presented at ACTRIMS Forum 2026, which demonstrated that cladribine maintains its efficacy and safety profile in older patients with relapsing MS. This study, involving 115 patients with a mean age of 60.8 years, showed low annualized relapse rates and treatment discontinuation rates regardless of age, supporting the therapeutic value of cladribine even in an aging population.
The researchers emphasized that the study utilized a large, real-world administrative claims database, providing valuable insights into treatment patterns and outcomes outside of controlled clinical trials. The data included patients with continuous enrollment for 12 months before and 48 months after the initiation of their respective DMTs. Propensity score weighting was employed to ensure that baseline characteristics were largely balanced across the different treatment cohorts.
While these findings are promising, it’s important to remember that this was an observational study, and therefore cannot prove cause and effect. Other factors, not accounted for in the analysis, contributed to the observed differences in outcomes. However, the data suggest that cladribine may represent a valuable treatment option for patients with MS, potentially offering improved adherence, reduced healthcare utilization, and lower costs compared to other commonly used DMTs.
The implications of these findings extend beyond individual patient care. Lower healthcare costs associated with cladribine could have a broader impact on the healthcare system, potentially freeing up resources for other medical needs. Further research is needed to confirm these findings and to identify the specific patient populations who may benefit most from cladribine treatment.
