I am a 28-year-old female with RRMS. I have walking difficulties and was treated with Cladribine (Mavenclad) in 2019 (year 1) and 2020 (year 2).
Walking has become increasingly difficult over the past year due to foot drop in my left ankle and ankle spasticity. Additionally, I had an injury in my left adductor muscle as a result of an exercise programme in 2024, which has also reduced my mobility. I had a worsening of leg weakness bilaterally in April, for which I received IV corticosteroids and had some improvement in my weakness symptoms.
My recent MRI was stable, and only old changes could be seen in the spinal cord.
I am JCV positive with an index of 1.09.
I am concerned about worsening disability, and the treatment options I am considering are natalizumab (Tysabri) injections with extended interval dosing, ublituximab (Briumvi) or a third course of oral cladribine (Mavenclad).
What would you advise?
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This woman does not have stable MS; i.e. she appears to be getting worse despite not having had any relapses or new lesions on MRI. On axis 1, she would be NEIDA (no evident inflammatory disease activity), but on Axis 2 she has SAW (smouldering associated worsening).
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