Mavenclad (Cladribine)

• Mavenclad is used as a disease‑modifying therapy for multiple sclerosis, targeting the relapsing disease process.
• Relapsing‑remitting multiple sclerosis (RRMS): reduces annual relapse rate and slows accumulation of disability.
• Secondary progressive multiple sclerosis with active disease (SPMS): decreases relapse frequency and mitigates disability progression.
• Relapsing forms of multiple sclerosis (overall): serves as an immunomodulatory therapy to lower disease activity and delay progression.

• Cladribine is a purine nucleoside analog that is taken up by lymphocytes and incorporated into DNA during replication. This incorporation triggers DNA strand breaks, leading to apoptosis of activated B and T cells. By selectively depleting these lymphocyte subsets, the drug reduces the autoimmune attack on myelin, providing immunomodulation and disease‑modifying effects in multiple sclerosis. The selective lymphocyte reduction is dose‑dependent and results in a sustained decrease in inflammatory activity.

Cladribine may cause a range of adverse reactions, which are classified by frequency and severity.

Common Side Effects

• Lymphopenia: reduced lymphocyte counts often observed during treatment.
• Headache: mild to moderate headache reported by patients.
• Nausea: occasional nausea, usually transient.
• Fatigue: general tiredness or lack of energy.

Serious or Rare Side Effects

• Severe lymphopenia: profound depletion of lymphocytes increasing infection risk.
• Opportunistic infections: including herpes zoster or fungal infections.
• Hepatic injury: elevated liver enzymes or hepatitis.
• Progressive multifocal leukoencephalopathy (PML): rare but potentially fatal brain infection.

• When prescribing Cladribine, several precautions and warnings should be observed to ensure patient safety.
• Pregnancy: contraindicated; risk of fetal harm classified as Category D.
• Breastfeeding: not recommended; drug may be excreted in breast milk.
• Infection risk: monitor for signs of infection and postpone treatment if active infection is present.
• Blood counts: perform regular monitoring of lymphocyte and complete blood counts during and after therapy.
• Vaccination: avoid live vaccines during treatment and for several weeks after the last dose.
• Store at ambient temperature: keep below 25 °C, retain in original packaging, and protect from moisture.

Cladribine can interact with other medicines, affecting its efficacy or safety.

Major Interactions (Avoid)

• Live vaccines: concurrent use may cause severe infection; avoid during and after therapy.
• Immunosuppressive agents: combined use can markedly increase risk of profound lymphopenia and infection.

Moderate Interactions (Monitor Closely)

• Antiviral drugs (e.g., acyclovir): may require dose adjustment due to overlapping immunosuppressive effects.
• CYP450 inhibitors: potential to increase Cladribine plasma levels, monitor for toxicity.
• Vaccines containing attenuated organisms: schedule appropriately to reduce infection risk.