Evidence map›Paper›PMID 42814343›Full record

ArticleNeurology and therapy2026

Impact of Oral Cladribine on TSPO-PET-Measurable Immune Cell Activation in Multiple Sclerosis.

Olli Rajalehto, Markus Matilainen, Jussi Lehto, Eveliina Honkonen, Mikko Koivumäki, Saara Wahlroos, Johan Rajander, Olavi Misin, Amelie Luoma, Sini Laaksonen and 4 more

Registry-linked trialAbstract read
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In one paragraph

Article in Neurology and therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04239820 (Effect of Cladribine Treatment on Microglial Activation in the CNS), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04239820 active not recruitingnot on this map

Effect of Cladribine Treatment on Microglial Activation in the CNS

TypeobservationalSponsorTurku University HospitalRan2020 to 2025Enrolled15ConditionsMultiple SclerosisArmsImaging
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Olli RajalehtoClinical Neurosciences, University of Turku, Turku, Finland.ORCID http://orcid.org/0009-0003-0982-7514
Markus MatilainenClinical Neurosciences, University of Turku, Turku, Finland.ORCID http://orcid.org/0000-0002-5597-2670
Jussi LehtoTurku PET Centre, University of Turku, Turku University Hospital, and Åbo Akademi University, Turku, Finland.ORCID http://orcid.org/0000-0002-2589-2549
Eveliina HonkonenClinical Neurosciences, University of Turku, Turku, Finland.ORCID http://orcid.org/0009-0006-4707-7277
Mikko KoivumäkiTurku PET Centre, University of Turku, Turku University Hospital, and Åbo Akademi University, Turku, Finland.ORCID http://orcid.org/0000-0001-5641-9677
Saara WahlroosRadiopharmaceutical Chemistry Laboratory, Turku PET Centre, University of Turku, Turku, Finland.ORCID http://orcid.org/0000-0003-0952-0945
Johan RajanderAccelerator Laboratory, Turku PET Centre, Åbo Akademi University, Turku, Finland.ORCID http://orcid.org/0000-0003-3591-0963
Olavi MisinClinical Neurosciences, University of Turku, Turku, Finland.ORCID http://orcid.org/0000-0003-2798-9982
Amelie LuomaClinical Neurosciences, University of Turku, Turku, Finland.ORCID http://orcid.org/0009-0001-5689-052X
Sini LaaksonenClinical Neurosciences, University of Turku, Turku, Finland.ORCID http://orcid.org/0000-0002-1273-8630
Anna VuorimaaClinical Neurosciences, University of Turku, Turku, Finland.ORCID http://orcid.org/0000-0002-0711-6917
Marcus SucksdorffClinical Neurosciences, University of Turku, Turku, Finland.ORCID http://orcid.org/0000-0003-0432-2931
Maija SarasteClinical Neurosciences, University of Turku, Turku, Finland.ORCID http://orcid.org/0000-0002-3424-5976
Laura AirasClinical Neurosciences, University of Turku, Turku, Finland. laura.airas@utu.fi.ORCID http://orcid.org/0000-0002-9751-5881

Funding

Jane ja Aatos Erkon Säätiö #220026The InFLAMES Flagship Program of the Research Council of Finland 337530The InFLAMES Flagship Program of the Research Council of Finland 357910The InFLAMES Flagship Program of the Research Council of Finland 358823The InFLAMES Flagship Program of the Research Council of Finland 374291
6 · The paper itself

Abstract

introductionOral cladribine reduces focal inflammatory activity in relapsing-remitting multiple sclerosis (RRMS). Preclinical studies suggest it may also modulate microglial activation. In this prospective, single-arm pilot study, we investigated the effect of oral cladribine on glial activation using 18 kDa translocator protein (TSPO) positron emission tomography (PET) in a real-world, longitudinal RRMS cohort.

methodsPeople with RRMS initiating oral cladribine underwent TSPO-PET with [

resultsFourteen people with RRMS and 14 healthy controls were enrolled. Baseline TSPO availability did not differ between groups. Over 18 months, TSPO availability quantified as percentage of TSPO-active voxels increased 21% in normal-appearing white matter (NAWM) (mean [95% CI] change 1.2 [0.2-2.3]; p = 0.026) and 16% in the whole brain (mean [95% CI] change 0.9 [0.01-1.8]; p = 0.047). Both the median (1st to 3rd quartile) annualized relapse rate (from 0.67 [0.17-0.67] to 0.00 [0.00-0.00]; p = 0.033) and the age- and BMI-adjusted sNfL Z-score (from 0.69 [0.16-1.22] to - 0.03 [- 0.39 to 0.21]; p = 0.038) decreased significantly.

conclusionTSPO-binding in the NAWM increased during oral cladribine treatment despite suppressed relapses and decreased sNfL Z-score. These exploratory findings raise the possibility that cladribine may have limited ability to control smoldering pathology. This possibility warrants further investigation in larger prospective studies.

trial registrationThis study was registered on ClinicalTrials.gov (NCT04239820) on January 21, 2020.

Indexed as

CladribineMicrogliaMultiple sclerosisPositron emission tomographyTSPO

Identifiers

PMID42814343

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