{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T05:34:43Z","timestamp":1767591283759,"version":"3.48.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cladribine is an immunomodulatory agent used in the treatment of relapsing\u2013remitting multiple sclerosis (MS) and, in some countries, for active progressive forms of MS. However, relatively few clinical observational studies have evaluated its effect.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included all patients with multiple sclerosis who were treated with cladribine at Nordland Hospital between April 2018 and September 2024. We aimed to evaluate the effectiveness of cladribine by assessing No Evidence of Disease Activity (NEDA)-3 over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 60 patients (62% women), of whom 58 had relapsing\u2013remitting multiple sclerosis, 1 had radiologically isolated syndrome, and 1 had secondary progressive disease and received at least 1 cyclic treatment. The mean age at the initiation of cladribine was 38.5\u202f\u00b1\u202f11.0\u202fyears, and the mean Expanded Disability Status Scale (EDSS) was 2.1\u202f\u00b1\u202f1.3. Two-thirds (65%) of the patients had received other disease-modifying treatment before cladribine. During the study period, eight patients switched or discontinued treatment, seven due to disease activity, two due to self-financed autologous stem cell treatment, one due to a drug overdose, and one for an unclear reason. Compared to patients with evidence of disease activity (EDA), those achieving NEDA-3 after 2\u202fyears were older at MS onset (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.046), and a larger proportion were treatment-na\u00efve at the start of cladribine (42% vs. 11%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.03). NEDA-3 was achieved by 36 (60%) patients at 1\u202fyear, 24 (40%) at 2\u202fyears, and 20 (33%) at 3\u202fyears. Mild to moderate adverse events were observed or reported in 13 (21.7%) patients; 1 developed lymphocytopenia grade 3, and 1 developed herpes zoster.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>One in three patients achieved NEDA-3 3\u202fyears after starting cladribine, with the best outcomes observed in treatment-na\u00efve patients, while its favorable safety profile and convenient dosing support long-term adherence and disease stability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2025.1698334","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T05:29:51Z","timestamp":1767590991000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["NEDA-3 using cladribine for multiple sclerosis: effectiveness data from a Norwegian hospital"],"prefix":"10.3389","volume":"16","author":[{"given":"Nora Berg","family":"Bj\u00f8rnevoll","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karl Bj\u00f8rnar","family":"Alstadhaug","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"102962","DOI":"10.1016\/j.msard.2021.102962","article-title":"The development and impact of cladribine on lymphoid and myeloid cells in multiple sclerosis","volume":"52","author":"Voo","year":"2021","journal-title":"Mult Scler Relat Disord"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1502","DOI":"10.1016\/S0140-6736(08)61620-7","article-title":"Multiple 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antibodies","volume":"9","author":"Alonso","year":"2023","journal-title":"Mult Scler J Exp Transl Clin"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1756286419887596","DOI":"10.1177\/1756286419887596","article-title":"Therapy with cladribine is efficient and safe in patients previously treated with natalizumab","volume":"12","author":"M\u00f6hn","year":"2019","journal-title":"Ther Adv Neurol Disord"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1177\/13524585211012227","article-title":"Effectiveness and safety of cladribine in MS: real-world experience from two tertiary centres","volume":"28","author":"Pfeuffer","year":"2022","journal-title":"Mult Scler"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e01422","DOI":"10.1002\/brb3.1422","article-title":"Validation of the multiple sclerosis diagnosis in the Norwegian patient registry","volume":"9","author":"Benjaminsen","year":"2019","journal-title":"Brain 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cladribine","volume":"232","author":"Al-Hashel","year":"2023","journal-title":"Clin Neurol Neurosurg"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1594","DOI":"10.1177\/1352458517727603","article-title":"Safety and efficacy of cladribine tablets in patients with relapsing-remitting multiple sclerosis: results from the randomized extension trial of the CLARITY study","volume":"24","author":"Giovannoni","year":"2018","journal-title":"Mult Scler"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1756286420922685","DOI":"10.1177\/1756286420922685","article-title":"Long-term effectiveness in patients previously treated with cladribine tablets: a real-world analysis of the Italian multiple sclerosis registry (CLARINET-MS)","volume":"13","author":"Patti","year":"2020","journal-title":"Ther Adv Neurol Disord"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"765837","DOI":"10.3389\/fneur.2021.765837","article-title":"Effectiveness of natalizumab in achieving no evidence of disease activity (NEDA-3)-data from a local Norwegian cohort","volume":"12","author":"Jaklin","year":"2021","journal-title":"Front Neurol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"103812","DOI":"10.1016\/j.msard.2022.103812","article-title":"Risk of fingolimod rebound after switching to cladribine or rituximab in multiple sclerosis","volume":"62","author":"Nygaard","year":"2022","journal-title":"Mult Scler Relat Disord"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1212\/NXI.0000000000200032","article-title":"Association of NEDA-4 with no long-term disability progression in multiple sclerosis and comparison with NEDA-3: a systematic review and Meta-analysis","volume":"9","author":"Rotstein","year":"2022","journal-title":"Neurol Neuroimmunol Neuroinflamm"}],"container-title":["Frontiers in 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