Real-World Perspectives on Switching Patients With Multiple Sclerosis From Anti-CD20 Therapy to Cladribine Tablets From

00:00:00: You are listening to an ADIS Journal podcast.

00:00:05: Hello, welcome to the podcast, Real World Perspectives on Switching Patients with MS from Anti-CD-Twenty Therapy to Cladrobene Tablets or CLAD-T from US-based Advanced Practice Providers.

00:00:21: I am Kristin Kutz, a certified physician assistant specializing in neurology working at Colorado Neurological Clinic in Colorado Springs.

00:00:31: Hi, I'm Courtney Roman, a certified nurse practitioner specializing in neurology at Rocky Mountain MS Clinic in Salt Lake City, Utah.

00:00:39: Thanks for joining us for this discussion.

00:00:41: To start, Kristin, can you give us an overview of multiple sclerosis or MS and its types?

00:00:48: Absolutely.

00:00:49: MS is a chronic autoimmune disorder of the central nervous system characterized by inflammation, demyelination, and neurodegeneration, leading to physical and cognitive challenges.

00:01:02: It varies in its course with some patients experiencing an initial clinically isolated syndrome or CIS, while others have relapsing remitting forms of MS.

00:01:14: Over time, some Progress to secondary progressive MS or SPMS, which is marked by increasing neurodegeneration and disability, while others have primary progressive MS or PPMS from the onset.

00:01:29: Can you also walk us through the current treatment approaches to manage MS?

00:01:34: Of course.

00:01:35: Conventionally, treatment approaches have aimed to manage symptoms, reduce relapses, and slow disease progression.

00:01:43: These include first and second line disease modifying therapies or DMTs.

00:01:49: First line therapies are used either early or soon after diagnosis and are typically prescribed for patients with relapsing forms of MS or RMS and include traditional injectables such as interferons, for example, interferon B. glateromeracetate, as well as oral DMTs such as dimethylfirmary, teraflunamine, or saponamine.

00:02:17: Second-line therapies are available for patients with more active disease or for those who have not responded adequately to first-line treatments.

00:02:26: These may be broadly characterized as high efficacy therapies or HET and include anti-CD-II monoclonal antibodies, such as Okrovizumum or Ofitumumum, Nanolizumum, Elantizumum, and oral immune reconstitution therapies, such as clad T.

00:02:45: That makes sense.

00:02:47: Increasingly, many patients with RRMS start on HETs as their initial or first-line treatment.

00:02:53: The treatment selection may be personalized and guided by shared decision-making, or SDM, a process between the patient and healthcare providers, or HCPs.

00:03:04: However, despite advances in MS treatment, several unmet needs still persist.

00:03:10: What are some of the biggest challenges that remain?

00:03:12: As you correctly pointed, even with these therapies, many patients continue to have disability progression.

00:03:19: Effective treatment options for progressive MS are so limited, particularly for non-active disease, which is characterized by the absence of any clinical relapses or radiological activity, yet with clinical progression, independence of relapse activity.

00:03:37: In addition, challenges affecting quality of life, such as fatigue, cognitive decline, and mobility issues are commonly reported by patients with MS.

00:03:48: Patients often report that their practical needs, including social and employment considerations, aren't always prioritized in their care plan.

00:03:57: Right.

00:03:58: Another concern is addressing medication challenges, such as convenience of administration for infusions.

00:04:05: optimizing dosing regimens for oral treatments, and reducing injection frequency for injectables.

00:04:12: These can create barriers to adherence.

00:04:15: During my practice, I've seen both healthcare providers and patients acknowledge treatment adherence challenges due to the complexity and side effects of treatments.

00:04:25: Aging presents additional challenges, especially due to the overlapping symptoms between age-related and MS-related comorbidities coupled with immunosynescence, which is the decrease in the number of immune cells such as naive T and B cells and disruption of the pro and anti-inflammatory balance.

00:04:45: Exactly.

00:04:46: And although more than a dozen DMTs are available for RMS, treatment interruption and discontinuations remain common challenges.

00:04:55: Hey, Kristen, let's take a closer look at the anti-CD-II monoclonal antibody therapies.

00:05:00: Can you elaborate on those?

00:05:02: Of course.

00:05:04: Therapeutically targeting immune cells has been a successful strategy in MS.

00:05:09: For example, B cells play a pivotal role in MS pathogenesis, driving the development of new strategies focused on B cell targets.

00:05:19: This led to the development of anti-CD-II monoclonal antibody therapies, which target CD-II positive B cells, reducing inflammation and disease activity.

00:05:31: Currently, we have three FDA-approved anti-CD-II DMTs.

00:05:37: Bocralizumam, indicated for patients with RMS, is the first approved drug for patients with PPMS.

00:05:45: It is given as an intravenous or IV infusion starting with two, three hundred milligram doses, two weeks apart, followed by six hundred milligrams every six months.

00:05:57: Next, we have Ofutumumum, which is a subcutaneous injection initially dosed at twenty milligrams at weeks zero, one, and two, then given monthly starting at week four.

00:06:11: Bublitexumab is another IV option starting with a hundred and fifty milligram dose, followed by four hundred and fifty milligrams two weeks later, and then four hundred and fifty milligrams every twenty four weeks thereafter.

00:06:25: Both Ophatumamab and Uglutexamab are approved for patients with RMS, including CIS, RRMS, and active secondary progressive disease in adults.

00:06:36: Both also offer convenient twice, yearly, or every six-month subsequent dosing.

00:06:42: that may improve adherence in some patients who prefer less frequent health care visits.

00:06:48: Additionally, the anti-CD-II DMTs have shown strong clinical outcomes in patients with MS, including high efficacy, reduced relapse rate, and reduced disability progression.

00:07:01: However, common adverse events or AEs include infections and infusion-related reactions.

00:07:08: Yes.

00:07:08: For example, in the opera one and two trials among one thousand six hundred and fifty-six patients with RRMS, ochrolizumab significantly reduced the annualized relapse rate, or ARR, by approximately forty-six percent compared with interferon beta one A, with relapse-free status in approximately eighty percent of patients over ninety-six weeks, and reduced the risk of twelve-week confirmed disability progression by forty percent.

00:07:37: In the oratorio trial, among seven hundred and thirty-two patients with PPMS, ochralisamab reduced the risk of twelve-week confirmed disability progression by twenty-four percent, with sustained benefits observed over six point five years in the extension phase.

00:07:55: In the opera one and two and oratorio studies, the most common adverse events with ochralizumab were infections, which occurred in nearly sixty percent and seventy-one percent of patients respectively, while infusion-related reactions occurred in thirty-four percent and forty percent of patients respectively.

00:08:16: So what about rituxabab?

00:08:18: I know it's not FDA approved for MS, but it's still used off-label for some patients with MS.

00:08:24: That's right.

00:08:24: Rotexamab is used as an off-label option and there is increasing evidence from studies that support the use of Rotexamab as a highly effective DMT with a low drug discontinuation rate and favorable safety profile in patients with MS.

00:08:41: Interesting.

00:08:42: Now let's talk about clad T, which works as an immune reconstitution therapy.

00:08:47: and is approved in the US for the treatment of relapsing multiple sclerosis to include RRMS and active SPMS in adults.

00:08:56: Kristen, can you walk us through the dosing and administration of clad T?

00:09:00: Sure.

00:09:01: Clad T provides durable disease control by its cytotoxic or depleting effects on pathological B and T lymphocytes through impairment of DNA synthesis, thereby selectively depleting lymphocytes.

00:09:16: Clad T offers a manageable safety profile and minimal treatment burden, which can be attributed to its oral administration and reduced dosing frequency.

00:09:27: Clad T is a ten milligram tablet administered orally at a cumulative dose of three point five milligrams per kilogram and divided into two yearly treatment courses of one point seven five milligram per kilogram per treatment course.

00:09:45: Its treatment is divided into two treatment cycles.

00:09:48: The cycle dosage is administered as one or two tablets once daily over four or five consecutive days with no more than two tablets daily.

00:10:00: That's definitely a different approach compared to injection or infusion based therapies.

00:10:05: What do we know about efficacy?

00:10:07: The high efficacy of clad T was demonstrated in the clarity trial, which is a ninety six week randomized controlled trial in thirteen hundred and twenty six patients with RMS who received three point five milligram per kilogram of clad T. Patients were eighteen to sixty-five years old and sixty-six percent were female.

00:10:31: The results were impressive.

00:10:33: Clad T significantly reduced the ARR by fifty-eight percent compared to placebo and eighty-one percent of patients experienced no relapses.

00:10:44: It is important to note that clarity is the only pivotal safety and efficacy study that includes patients with MS up to sixty-five years of age.

00:10:54: While the cutoff age was lower than sixty and pivotal trials of other approved DMT therapies, including Okuromuzumem.

00:11:02: Furthermore, the clarity extension study demonstrated the durability of clad T's efficacy.

00:11:09: Here, ninety-eight patients with RMS with a mean age of forty-one years and sixty-eight percent female who received clad T, three point five milligrams per kilogram in the original clarity trial were given placebo for two years.

00:11:27: Remarkably, about seventy-five percent of these patients were reigned relapse-free at year four.

00:11:34: Clad T was generally well tolerated and most of the reported adverse events were mild to moderate with a low risk of severe lymphopenia in these trials.

00:11:43: Patients who experienced greater than or equal to grade three lymphopenia recovered to grade zero to one by the end of the extension study and there was no evidence of cumulative immunosuppression or increased malignancy risk with clad T.

00:11:58: That's correct.

00:11:59: Additionally, an age stratified analysis with subgroups of patients aged forty-five years or less or greater than forty-five years confirmed that clad T, three point five milligrams per kilograms, was efficacious in patients regardless of age.

00:12:17: Therefore clad T may be considered a viable treatment option for older patients with MS aged fifty years or older.

00:12:26: With multiple options like anti-CD-II and clad T, when should HCPs consider switching therapies?

00:12:34: MS treatment decisions are complex.

00:12:36: What key recommendations should guide this process?

00:12:39: That's a great question.

00:12:41: As for the American Academy of Neurology or AAN practice guidelines, it is recommended to consider switching when a patient experiences at least one relapse.

00:12:52: two or more unequivocally new MRI-detected lesions or increased disability over a one-year period despite being on a DMT, as these signs indicate that the current treatment may not be effectively controlling the disease.

00:13:08: It is also essential to evaluate the degree of disease activity, treatment adherence, side-effect profiles, and the mechanism of action of different DMTs when making the decision to switch.

00:13:20: Beyond disease activity, what other factors should be considered?

00:13:25: Tolerability and safety play a big role.

00:13:28: Oh, absolutely.

00:13:30: Side effects or AEs are another major consideration.

00:13:34: If a patient is struggling with AEs that negatively impact adherence, or if there are persistent laboratory abnormalities, switching to a better tolerated therapy is reasonable.

00:13:44: It is recommended that clinicians should discuss switching to a DMT with lower risk of progressive multifocal leukoencephalopathy or PML with patients, especially with those who are or have become John Cunningham virus antibody positive or JC virus antibody positive with an index of greater than zero point nine while on therapy.

00:14:08: This is especially important for patients receiving immunosuppressive therapies such as natalizumab, rituximab or ochralizumab.

00:14:16: Agents associated with increased risk of PML, particularly when there's a history of prior immunosuppressive treatment.

00:14:23: Additionally, both HCP judgment and patient preferences must be considered when considering a switch.

00:14:30: It's clear that multiple factors influence the decision to switch MS therapies.

00:14:35: But how do these recommendations translate into real-world clinical practice?

00:14:39: Have we gained any insights from HCPs who have already navigated this transition from anti-CD-II therapies to clad T?

00:14:46: Yes, we conducted a real-world retrospective survey among HCPs in the US with the aim of understanding the rationale or perception of HCPs based on their experience.

00:14:59: of switching their patients from an anti-CD-II therapy to clad T. Additionally, we assessed whether the reasons to switch were comparable with age-stratified subgroups of patients aged fifty years or less or fifty years or older.

00:15:17: Key endpoints of this study included most common reasons for transitioning patients from an anti-CD-II therapy to clad T. The anti-CD-II therapy discontinuation and adverse events will on anti-CD-II therapy and after transitioning to clad T. A total of four hundred and seven neurology HCPs who treated patients with MS using an anti-CD-II therapy and transition them to clad T were approached with a questionnaire via email to complete a de-identified electronic survey.

00:15:53: Patient medical records were used to complete the questionnaire.

00:15:57: The survey was closed after one hundred eligible patient entries were received.

00:16:02: The HCP to patient ratio was one to one.

00:16:05: The majority of survey respondents were MDs at seventy seven percent, nurse practitioners at seventeen percent, DOs three percent, physician assistants one percent and others two percent.

00:16:22: What were the demographics and disease characteristics of the patients?

00:16:26: The mean age of patients was forty-seven years.

00:16:29: Seventy percent were female and the majority were white at sixty-seven percent.

00:16:34: Approximately sixty-nine percent of patients had RRMS, while twenty-nine percent had SPMS, and only two percent had CIS.

00:16:45: Among the age stratified subgroups, Fifty patients were aged less than fifty years of age, and forty were aged fifty years or older.

00:16:55: Interesting.

00:16:56: What was the treatment history of these patients?

00:16:59: Before transitioning to clad T, sixty-one percent of patients were treated with okravisumum, twenty-five percent with rituximum, thirteen percent with ophetumum, and one percent with ublituximum.

00:17:13: Prior to initiation of anti-CD-II therapy, Forty-seven percent of patients have received DMTs.

00:17:22: Kristen, what were the common reasons influencing the switch from anti-CD-II therapy to clad T according to the survey?

00:17:29: HCPs reported that the most common reasons were perception of increased efficacy of clad T on relapses in fifty-five percent of patients and also the perception of increased disability progression in fifty-four percent of patients.

00:17:43: But

00:17:45: that's interesting.

00:17:46: Were there any other factors that contributed to this transition?

00:17:49: Yes.

00:17:50: Perception of increased efficacy on MRI-detected disease activity as reported by HCPs in thirty-nine percent of patients.

00:17:59: Thirty-three percent switched due to a desire to avoid long-term immunosuppression with an anti-CD-II therapy.

00:18:07: Twenty-two percent switched as they preferred not being on a long-term and continuously administered DMT.

00:18:14: Seventeen percent switch because they preferred a short course dosing of clad T. Sixteen percent switch due to perception of fewer infections.

00:18:25: Interesting.

00:18:26: In fact, approximately eighty-seven percent of treatment switching may occur within six months after discontinuing a DMT.

00:18:33: Given this, can you elaborate on common reasons and general clinical indicators for switching from anti-CD-Twenty therapy to clad T in clinical or community practice?

00:18:43: Sure, some reasons might be suboptimal response to the initial DMT with a persistent relapse rate similar to pretreatment phase, ongoing MRI activity, or worsening of irreversible neurological disability.

00:19:00: Partial response to initial treatment, not meeting criteria for escalation to a second line treatment.

00:19:07: Adverse events or tolerability issues that affect patient safety or quality of life.

00:19:13: presence of PML, that may affect compliance and necessity, consideration of a treatment switch.

00:19:19: And lastly, older age at treatment start is also associated with increased risk of treatment switching.

00:19:26: So what factors specifically drove the decision to discontinue anti-CD-II therapy?

00:19:31: What insights do we have from the survey regarding common reasons for discontinuation of anti-CD-II therapy?

00:19:38: According to the survey, HCPs reported that the most common reasons for discontinuing anti-CD-II therapies were relapses in forty-one percent of patients and continued clinical activity in twenty-six percent.

00:19:53: Other reasons included new or enlarging T-II lesions in twenty-two percent of patients, physical or cognitive decline disability progression in twenty-one percent.

00:20:06: patient preferences in fourteen percent, insurance coverage in fourteen percent, patient fear of infection in thirteen percent, opportunistic infections including PML in twelve percent, desire for different frequency or mode of administration in ten percent, infusion or injection site reactions in six percent, and gadolinium enhancing lesion in six percent.

00:20:34: In addition to the reasons that we just discussed, there were other factors, including patient dissatisfaction with various treatment related issues such as injection fatigue, pain or poor management of side effects, leading to reduced adherence or therapy discontinuation if these issues could not be improved.

00:20:56: Some patients with MS fine injectable therapies intolerable due to discomfort.

00:21:02: In such cases, we should consider changing to non-injectable or less frequently injectable DMTs.

00:21:09: Pregnancy is another event that requires immediate DMT interruption in women with MS.

00:21:16: Lastly, patients in the secondary progressive phase of MS do not benefit significantly from any of the currently available DMTs and therapy should be discontinued.

00:21:28: Since treatment tolerability in AEs were among the key factors in the decision-making process, what were the most common AEs experienced by patients with MS while on anti-CD-II therapy and after transitioning to clad T according to the survey?

00:21:44: That's an important consideration.

00:21:46: Based upon survey results, the most reported adverse events while on anti-CD-II therapies were reduction in immunoglobulin levels reported by HCPs in twenty-three percent of patients, infusion reactions in sixteen percent, and opportunistic infections including herpes zoster, PML, or fungal infections in fifteen percent of patients.

00:22:12: The most common adverse events reported after switching to clad T were headache in twenty-four percent of patients, nausea in sixteen percent, and back pain in eight percent of patients.

00:22:26: Notably, adverse events suggested of immunosuppression, such as reductions in immunoglobulin levels or opportunistic infections, were not reported in patients who had transitioned to clad T. No new safety signals infections or immunoglobulin reductions were observed.

00:22:46: Overall, the safety profile of clad T was consistent with the previously reported safety data from randomized clinical trials and other real-world studies of clad T.

00:22:57: Kristen, you mentioned earlier that the survey provides insights on age stratified subgroups, those less than age fifty, as well as those age fifty and older.

00:23:07: What insights do we have on impact of age on the rationale for switching from anti-CD-II therapy to clad T?

00:23:14: In patients aged fifty years or less, according to HCPs, the main reasons for switch from anti-CD-II therapies to clad T were notably the perception of increased efficacy on relapses, seen in sixty percent of patients, and the perception of increased efficacy on disability progression in fifty-eight percent, and on MRI activity in forty-two percent, whereas in patients fifty years or older, the desire to avoid long-term immunosuppression was a key factor in choosing clad T after anti-CD-twenty therapy, as noted in forty-five percent of patients.

00:23:55: What were the common reasons for discontinuing anti-CD-II therapies among these subgroups?

00:24:00: In addition to the most common reasons for discontinuing anti-CD-II therapies discussed for the overall group, other common reasons observed by the HCPs in the subgroups, either fifty years or less or fifty years or greater, were infusion reactions at eight and five percent, gadolinium enhancing lesions at six and eight percent, recurrent infections at four and eight percent and severe infections at four and five percent respectively.

00:24:31: Notably, a higher proportion of patients under fifty discontinued anti-CD-II therapies due to a fear of infections at eighteen versus eight percent compared to those over age fifty.

00:24:44: In contrast, newer and larger T-two lesions at sixteen and twenty-three percent and physical or cognitive disability progression at fourteen and twenty-three percent respectively were more common reasons for discontinuation of anti-CD-twenty in patients over fifty years of age.

00:25:03: Are there any insights on AEs with respect to age subgroups?

00:25:07: Yes, according to HCPs, with anti-CD-twenty therapy a higher proportion At thirty-eight percent versus sixteen percent of patients fifty years or older compared with patients less than fifty years of age experience reduction in serum immunoglobulin levels.

00:25:24: Will both subgroups experience opportunistic infections at eighteen and fifteen percent and infusion reactions at sixteen and twenty percent respectively in comparable precautions?

00:25:37: Are there any additional studies supporting the transition from anti-CD-II therapies to clad T or the findings of this retrospective survey?

00:25:45: Well, direct studies on transitioning from anti-CD-II therapies to clad T are limited.

00:25:52: However, a study by Daniel O'Neill and Suzanne Hodgkinson in twenty-twenty conducted in a subgroup of seventeen patients with MS who switched from anti-CD-twenty therapy to clad T reported a lack of perceived efficacy with the anti-CD-twenty DMT, ochralizumum, as the main reason to switch to clad T in almost all patients.

00:26:16: In this short-term efficacy and safety study, the effect on lymphocytes remained predictable despite the fact that clad T was initiated at or around the lower limit of normal.

00:26:28: And there were reported adverse events on clad T that were comparable to those reported in other studies.

00:26:35: Courtney, can you add any additional information?

00:26:38: Sure.

00:26:39: At the twenty twenty-two European Committee for Treatment and Research in MS, Ekstrom's Congress, Dr.

00:26:46: Donald Nagrowski, a neurologist at Nagrowski Neurology and a clinical assistant professor at the Florida State University College of Medicine presented results of a real-world study.

00:26:56: in the U.S.

00:26:57: We have eighty-four patients with relapsing MS aged eighteen to seventy-four years.

00:27:02: This study included thirty-two patients with MS who switched from high efficacy infusion treatments and received greater than or equal to one dose of clad T and among these, fourteen were transitioned from ochralizumab to clad T. Overall, the patients who switched from high efficacy infusion treatments to clad T showed a reduced annualized relapse rate and good tolerability to clad T. The annualized relapse rate was reduced to zero point one seven from zero point five nine at year one.

00:27:35: Approximately nine percent of patients reported grade zero lymphopenia, six percent reported grade one lymphopenia, forty four percent reported grade two lymphopenia, forty one percent reported grade three lymphopenia, and none reported grade four lymphopenia.

00:27:53: The most common AEs occurring at a rate higher than five percent included fatigue, upper respiratory tract infections, urinary tract infections, and headache, as reported in the retrospective study.

00:28:06: This study had a short follow-up and results should be interpreted with caution and reviewed as preliminary.

00:28:13: We have seen from the studies that transitioning from anti-CD-II therapy to clad T can be beneficial.

00:28:19: However, this process may come with uncertainties for both HCPs and patients.

00:28:24: What are some of the key challenges associated with this switch?

00:28:27: That's a really important question.

00:28:29: Before starting clad T, several precautions should be taken.

00:28:34: First, the absolute lymphocyte count should be within the normal range.

00:28:38: Additionally, a baseline MRI scan taken within three months before starting treatment is recommended to establish a reference for monitoring disease activity.

00:28:49: Patients should have antibodies against varicella, zoster virus, and the presence of active or latent infections such as tuberculosis, hepatitis B, hepatitis C, or HIV and other contraindications such as pregnancy or renal impairment should be rolled out.

00:29:09: Well, that makes sense.

00:29:10: Another challenge we often face is managing the transition between therapies.

00:29:15: In general, immediate DMT transitions are often impractical, requiring immune reconstitution before starting the next therapy.

00:29:23: Clinicians face challenges in managing the gap between treatments and determining the optimal washout period.

00:29:29: Delaying clad T initiation to allow immune recovery after discontinuing anti-CD-II therapies may create a window for disease reactivation.

00:29:38: That's correct.

00:29:40: But on the other hand, starting clad T too soon after anti-CD-II therapy, especially given the sustained B cell depletion caused by anti-CD-II therapies, could lead to overlapping immunosuppressive effects, increasing the risk of infections and lithopenia.

00:29:57: It's definitely a delicate balance.

00:30:00: Are there any specific patient populations that require additional monitoring?

00:30:04: Yes, particularly patients with hypogamma globulinemia.

00:30:08: These patients should be closely monitored for signs and symptoms of infection, especially during the first few months of clad T treatment.

00:30:17: Additionally, patient preferences and lifestyle considerations play a role in decision-making.

00:30:22: Factors like insurance denials and pre-authorization requirements may also lead to treatment delays.

00:30:28: Let's discuss some of these economic benefits associated from switching from anti-CD-II therapy to clad T. In general, patients who switched to oral DMTs had the lowest all-cause total cost of care and MS-related health care expenses.

00:30:44: With that said, health care utilization is reduced with clad T compared with anti-CD-II therapies.

00:30:52: One of the reasons is clad T's unique dosing schedule, two treatment courses over two years, which minimizes the frequency of health care visits.

00:31:01: Any further insights on this, Kristen?

00:31:03: Yes, you bring up a very good point.

00:31:06: CladT is an oral therapy, eliminating the need for infusion centers, which reduces direct health care costs, provides ease of administration, and avoids infusion-related adverse events.

00:31:19: CladT needs less monitoring post-initiation, thereby potentially reducing costs compared with anti-CD-II therapies.

00:31:28: To further support this, as per a recent study, the absolute cost for administration and monitoring per patient over the ten-year time horizon is lower for clad T than with first-line anti-CD-II DMTs, such as OFA Tumamab and Ochralizumab.

00:31:45: We've discussed the clinical and practical factors influencing treatment decisions, but another critical aspect is shared decision-making, or SDM.

00:31:54: Kristen, how does SDM between HCPs and patients influence the transition between treatments?

00:32:00: SDM is essential in MS care.

00:32:03: NMS involving patients in treatment decisions improve patient satisfaction, adherence and outcomes and reduces treatment burden.

00:32:12: What are your thoughts Courtney?

00:32:14: Certainly switching DMTs involves new routines, risks, and uncertainties, often causing emotional stress in patients due to fears of disease progression and lack of treatment effectiveness.

00:32:26: Patient-centered decisions in SDM should address both initial and subsequent treatment choices.

00:32:32: Okay, let's wrap this up and review some take-home messages.

00:32:36: Well, this has been an insightful and engaging discussion.

00:32:39: To summarize, HCPs have considered transitioning from anti-CD-II therapy to clad T with their decision primarily driven by clad T's perceived effectiveness in reducing relapses and slowing disability progression.

00:32:53: Additional factors included the desire to avoid long-term immunosuppression and a preference for the short dosing schedule of clad T. In particular, for patients aged Equal to or greater than fifty years impacts on the immune system were key factors in the decision to discontinue current therapy and switch to clad T.

00:33:14: Absolutely and overall health care providers regarded clad T as a safe and effective option for patients with MS who are transitioning from anti-CD-II therapies.

00:33:26: In the survey, more than fifty percent of HCP's reported perceived improvements in relapse control and disability progression as the most common reasons for initiating the switch to clad T. No new safety signals, infections or immunoglobulin reductions were observed, and adverse events suggestive of immunosuppression or opportunistic infections were not reported in patients who transitioned to clad T. Thank you for listening to Courtney and I today.

00:33:55: We really appreciate it.

00:34:01: You can listen to more podcasts by subscribing to ADIS Journal Podcasts with your preferred podcast provider.

00:34:08: or by visiting the journal website.

00:34:11: For a full list of declarations, including funding and author disclosure statements and copyright information, please visit the article page on the journal website.

00:34:21: The link to the article page can be found in the podcast description.