Considering Cladribine Treatment for Older Adults With Relapsing MS: Amy Gutierrez, MD, FAAN

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"Looking at our older patients, what percentage of them will go on to need retreatment because they experienced clinical or radiographic relapse? That’s information that we really have not assimilated and gathered, but I think that would be interesting to look at because potentially in our older patients this may be the last treatment they may need for their MS."

In older adults with relapsing multiple sclerosis (MS), treatment decisions are increasingly complex as patients live longer and accumulate age-related comorbidities and immunologic changes. Questions remain regarding how long to continue disease-modifying therapy, whether and when to de-escalate, and how to balance efficacy with risks such as infection and treatment-related lymphopenia in patients aged 50 years and older, particularly those in their mid-60s and beyond.

A new real-world subgroup analysis presented at the recently concluded 2026 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, held May 27-29, Charlotte, North Carolina, examined the effectiveness and safety of cladribine (Mavenclad; EMD Serono) in older patients with relapsing MS. Presented by Amy Gutierrez, MD, FAAN, the study evaluated infection risk, lymphocyte dynamics, and overall safety of cladribine tablets among patients aged 50 years and older, including a subgroup aged 65 years and older, to help inform treatment strategies in this growing patient population.

In an interview at the meeting, Gutierrez, a neurologist at Orlando Health, discussed the rationale for focusing on aging patients with MS, key safety and hematologic findings from the cladribine subgroup analysis. She noted how these real-world data fit into broader questions around continuing, stopping, or de-escalating therapy in later life. Gutierrez also addressed knowledge gaps that remain regarding retreatment needs and long-term outcomes for older patients treated with short-course immune reconstitution therapies such as cladribine.

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REFERENCES
1. Katz J, Hughes B, Gutierrez A, et al. Real-World Effectiveness and Safety of Cladribine Tablets in Older Patients with Relapsing Multiple Sclerosis: Insights from the Aging Study Subgroup Analysis,. Presented at: 2026 CMSC Annual Meeting; May 27-29; Charlotte, North Carolina. Abstract DMT02.