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You have probably seen on the news recently that a ‘gamechanger’ treatment for Multiple Sclerosis (MS), cladribine, has been approved for more widespread use in the NHS earlier this year. Keeping up to date with recent developments in medicine, and how it affects the NHS is an important aspect of medical interview preparation and demonstrates your interest and insight into the field. So, what is this new treatment rollout and what are its implications?
MS stands for Multiple Sclerosis, which is a neurological condition that affects the brain and spinal cord. It is a chronic autoimmune disease, meaning the bodys immune system mistakenly attacks the nerve cells of the body. More specifically, it attacks the myelin sheath cells in the central nervous system (the brain and spinal cord). Myelin is a special type of cell which surrounds neurons and helps speed up the nerve signals as they travel through the body. Therefore, when these cells are damaged in multiple sclerosis, the bodys ability to communicate between the brain and the nervous system is compromised, leading to a range of symptoms such as difficulty with movement, vision impairment, weakness and sensory disturbances. There is currently no cure for MS and is a lifelong condition, currently affecting over 150,000 people in the UK.
There are a few different types of MS, but the most common is relapse-remitting, which affects 85% of MS patients. In this type, patients experience episodes of worsening symptoms lasting days to weeks, which then improve and are stable for a period of time, however do not reach the same level of function as before the relapse. A significant aspect of MS management involves treating these relapses, which is outlined in the next section.
According to the NICE guidelines for MS treatment, general management of patients involves conservative measures such as lifestyle advice, access to support and education about the disease. There are some treatments currently available aimed at reducing the risk of relapse called DMT’s (Disease-Modifying Treatments), which typically require invasive procedures such as injections, or infusions which require treatment in hospital. The main aspect of MS treatment involves treating the relapses, in which patients symptoms are dramatically worsened.
Although relapse treatment varies according to the specific symptoms the patient is suffering, admission to hospital is almost always required, where patients are given high doses steroids which come with their own risks and side effects. Additionally, patients often experience complications as a result of their relapses which require treatment, for example, motor problems and pain which can require long term treatment and physiotherapy and impact patients quality of life.
Cladribine is a chemotherapy drug in tablet form which acts to reduce the number of lymphocytes in the body, which is a type of white blood cell involved in the immune system. As well as being used for some cancers, in Multiple Sclerosis it interrupts the damage caused to the myelin sheath cells. Cladribine has previously been used for MS patients, however only for the rarer types. The drug regime requires only 20 days of treatment over four years and can safely be used in pregnancy.
The new treatment rollout, approved in early 2025 gives cladribine access to a much wider group of MS patients, including the relapse-remitting type as outlined above. The NHS is the first healthcare system in Europe to widen this treatment access. Recent trials showed 80% of patients experienced no relapses and developed 7.5x fewer new brain lesions compared to placebo over a period of two years.
In your interviews, you may be asked about what interesting news or topics you have read about in medicine which aims to assess your interest and curiosity in medicine. Most students can answer this by reciting something they have read or found interesting, however candidates who really stand out are the ones who can reflect on this information and consider what implications they may have and why this is relevant to medicine, or the healthcare system. This section outlines a few considerations you may have about the new MS treatment roll out, but reflect on it yourself and see what other points you can come up with.
Firstly, current treatment for MS which aims to reduce the relapse rate and improve quality of life are generally invasive, and often require hospital admission. In contrast, cladribine has been termed a ‘take at home’ treatment as it is an oral tablet and only requires 20 days of treatment over four years. This means patients benefit as they do not need to travel to clinics or hospitals to receive treatment, and the mode is non-invasive and for a brief period of time, making it a more comfortable and convenient option.
Secondly, as outlined above, treatment for MS relapses and their complications often requires hospital admissions and a range of therapies. Cladribine has shown remarkable effects in trials in reducing the number of relapses, with 80% experiencing none over a two year period. Therefore, patients’ quality of life can be improved, experiencing less distressing relapses and less time receiving treatment for them. Additionally, treating MS and its relapses is costly for the NHS, requiring bed spaces for in-patient stays and frequent hospital appointments. An article by the NHS estimates this new rollout will save thousands of hours in clinical time and hospital appointments each year, which can then be used for other patients and aid in reducing wait times.
One trait of the relapse-remitting type of MS is that after a relapse, although symptoms will improve, function will not return to the pre-relapse level, meaning over time and with more relapses, function slowly declines and more complications emerge. As cladribine has a significant effect at reducing the number of relapses, patients will benefit from maintained function and less side effects for longer. Finally, cladribine has the added benefit of being safe to use in pregnancy, which many previous treatments did not have.
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